Provider Demographics
NPI:1629515143
Name:RUIZ, JANET (DPT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 WILSHIRE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5779
Mailing Address - Country:US
Mailing Address - Phone:424-354-9633
Mailing Address - Fax:
Practice Address - Street 1:2254 30TH ST
Practice Address - Street 2:APT E
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2035
Practice Address - Country:US
Practice Address - Phone:310-699-1162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-22
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT292441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist