Doctor Name: | DR. LARRY L RUTLEDGE |
NPI Number: | 1245236835 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | PS-008498-L |
Business Practice Address: | 111a Roosevelt Blouevard Johnstown, PA - 15901 |
Business Phone Number: | 8146194223 |
Business Fax Number: | 8145390985 |
Mailing Address: | 1086 Franklin St, JOHNSTOWN |
State: | PA |
Postal Code: | 159054305 |
Phone Number: | 8144108330 |
Fax Number: | 8144108331 |
NPI Enumeration Date: | 06/28/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | PS-008498-L |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |