Provider Demographics
NPI:1376698514
Name:RUBY MOUNTAIN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:RUBY MOUNTAIN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONYCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-423-5233
Mailing Address - Street 1:1910 IDAHO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2635
Mailing Address - Country:US
Mailing Address - Phone:775-777-7722
Mailing Address - Fax:775-777-7900
Practice Address - Street 1:1910 IDAHO ST STE 101
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2635
Practice Address - Country:US
Practice Address - Phone:775-777-7722
Practice Address - Fax:775-777-7900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RODNEY D STEWART
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-25
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505290Medicaid
NV38224Medicare ID - Type UnspecifiedMEDICARE