Provider Demographics
NPI:1225142631
Name:RUOTI, RICHARD G (PH D; PT)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:RUOTI
Suffix:
Gender:M
Credentials:PH D; PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:1950 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3250
Practice Address - Country:US
Practice Address - Phone:702-735-1501
Practice Address - Fax:702-735-1875
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT00255IL225100000X
NV1954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002885OtherAETNA (HMO)
232088952OtherTRI-CARE
50014014OtherCAPITAL BLUE CROSS
PA122262OtherHIGHMARK BLUE SHIELD
PA1011157030001Medicaid
PA0023832000OtherINDEPENDENCE BLUE CROSS
5635441OtherAETNA (PPO)
NV1702161Medicaid
PA122262OtherHIGHMARK BLUE SHIELD
0002885OtherAETNA (HMO)
NVGC779AMedicare PIN
PA122262OtherHIGHMARK BLUE SHIELD