Provider Demographics
NPI:1285199588
Name:RUBY, SAMANTHA ANN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ANN
Last Name:RUBY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 WILSHIRE BLVD STE 311
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5679
Mailing Address - Country:US
Mailing Address - Phone:310-453-6166
Mailing Address - Fax:310-453-6154
Practice Address - Street 1:17207 VENTURA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4035
Practice Address - Country:US
Practice Address - Phone:818-386-8070
Practice Address - Fax:818-386-8071
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist