Provider Demographics
NPI:1467850750
Name:RUIZ, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 FM 1091
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:TX
Mailing Address - Zip Code:78075-3030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2951 HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:GEORGE WEST
Practice Address - State:TX
Practice Address - Zip Code:78022-3845
Practice Address - Country:US
Practice Address - Phone:361-449-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2072433225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant