Provider Demographics
NPI:1598781700
Name:RUIZ HERNANDEZ, GLADYS S (PT)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:S
Last Name:RUIZ HERNANDEZ
Suffix:
Gender:F
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:HC 2 BOX 7274
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9102
Mailing Address - Country:US
Mailing Address - Phone:787-602-7467
Mailing Address - Fax:787-898-3438
Practice Address - Street 1:CARR # 119 RAMAL 486 KM 2 HM 1 INTERIOR
Practice Address - Street 2:BO. ZANJAS,CARR PIPO CRESPO,SECTOR VIEQUEZ
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-9102
Practice Address - Country:US
Practice Address - Phone:787-602-7467
Practice Address - Fax:787-898-3438
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1052225100000X
FL7035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50437OtherPMC
825316OtherMMM
50437OtherPMC