Basic Information
Provider Information
NPI: 1861043218
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAYER
FirstName: RUTH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
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Mailing Information
Address1: 6050 TACOMA MALL BLVD STE 300
Address2:  
City: TACOMA
State: WA
PostalCode: 984096828
CountryCode: US
TelephoneNumber: 2535815200
FaxNumber:  
Practice Location
Address1: 19321 MOUNTAIN HWY E STE 100
Address2:  
City: SPANAWAY
State: WA
PostalCode: 983878450
CountryCode: US
TelephoneNumber: 2538468919
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/26/2019
LastUpdateDate: 09/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT61001363WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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