Provider Demographics
NPI:1003048760
Name:JUAN RUIZ MASSAGE REHABILITATION
Entity Type:Organization
Organization Name:JUAN RUIZ MASSAGE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:786-210-7857
Mailing Address - Street 1:2001 NW 7TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3479
Mailing Address - Country:US
Mailing Address - Phone:786-210-7857
Mailing Address - Fax:305-229-9169
Practice Address - Street 1:2001 NW 7TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3479
Practice Address - Country:US
Practice Address - Phone:786-210-7857
Practice Address - Fax:305-229-9169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39289261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA39289OtherINSURANCE