Provider Demographics
NPI:1053695510
Name:RUITER, CHRISTIAN MICHEAL (LMP)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MICHEAL
Last Name:RUITER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3030
Mailing Address - Country:US
Mailing Address - Phone:360-980-2202
Mailing Address - Fax:
Practice Address - Street 1:6915 LAKEWOOD DR W STE A2
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-3299
Practice Address - Country:US
Practice Address - Phone:253-589-8843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60188531225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist