Provider Demographics
NPI:1326043175
Name:RUIZ, PABLO JR (PT)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:RUIZ
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N LITCHFIELD RD
Mailing Address - Street 2:STE 155
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1333
Mailing Address - Country:US
Mailing Address - Phone:623-882-9787
Mailing Address - Fax:
Practice Address - Street 1:250 N LITCHFIELD RD
Practice Address - Street 2:STE 155
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1333
Practice Address - Country:US
Practice Address - Phone:623-882-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1078OtherTEXAS DEPT OF LABOR
AZ6400097OtherEVERCARE
AZ7499498OtherAETNA
AZ2Z2985OtherHEALTHNET
AZ783002OtherMERCY CARE PLAN
AZ0154410OtherDEPT OF LABOR
AZ1078OtherLICENSE NUMBER
AZ783002OtherAHCCCS
AZAZ0299850OtherBCBS
AZAZ0299850OtherBCBS
AZ6400097OtherEVERCARE