Provider Demographics
NPI:1225126105
Name:DE RUEDA, EVELYN SALVADOR (PT)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:SALVADOR
Last Name:DE RUEDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 BELLE AIRE CT
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-3852
Mailing Address - Country:US
Mailing Address - Phone:870-866-5981
Mailing Address - Fax:870-460-0946
Practice Address - Street 1:145 BELLE AIRE CT
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-3852
Practice Address - Country:US
Practice Address - Phone:870-866-5981
Practice Address - Fax:870-460-0946
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist