Provider Demographics
NPI:1306010939
Name:RUIS, JOSEPH SAMUEL II (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:SAMUEL
Last Name:RUIS
Suffix:II
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-0086
Mailing Address - Country:US
Mailing Address - Phone:904-316-9050
Mailing Address - Fax:
Practice Address - Street 1:106 E MACCLENNY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2120
Practice Address - Country:US
Practice Address - Phone:904-316-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 16002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer