Provider Demographics
NPI:1275872954
Name:ISIDRO, RUBY N (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:N
Last Name:ISIDRO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13312 COLONY SQUARE DR
Mailing Address - Street 2:APT. 3125
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4391
Mailing Address - Country:US
Mailing Address - Phone:319-330-2972
Mailing Address - Fax:
Practice Address - Street 1:2511 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-1653
Practice Address - Country:US
Practice Address - Phone:407-343-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 16694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist