Provider Demographics
NPI:1518434026
Name:RUIZ, MAURICIO (PT)
Entity Type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:RUIZ
Suffix:
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 1:7109 N BARTLETT AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6473
Mailing Address - Country:US
Mailing Address - Phone:956-319-5740
Mailing Address - Fax:956-727-4445
Practice Address - Street 1:7109 N BARTLETT AVE STE 109
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6473
Practice Address - Country:US
Practice Address - Phone:956-727-2122
Practice Address - Fax:956-727-4445
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1369850225100000X
TX2090566225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant