Provider Demographics
NPI:1649394651
Name:RUIZ PHYSICAL THERAPY
Entity Type:Organization
Organization Name:RUIZ PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:RAMAPRIYA
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:831-373-7222
Mailing Address - Street 1:5308 DERRY AVE
Mailing Address - Street 2:UNIT K
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4530
Mailing Address - Country:US
Mailing Address - Phone:831-373-7222
Mailing Address - Fax:818-594-3348
Practice Address - Street 1:5308 DERRY AVE
Practice Address - Street 2:UNIT K
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4530
Practice Address - Country:US
Practice Address - Phone:831-373-7222
Practice Address - Fax:818-594-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA6820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty