Provider Demographics
NPI:1689967168
Name:RUIZ, ANTHONY D (LMT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:RUIZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 RIVERSTONE WAY
Mailing Address - Street 2:#924
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0786
Mailing Address - Country:US
Mailing Address - Phone:817-690-3788
Mailing Address - Fax:
Practice Address - Street 1:1907 WINDSOR PL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1845
Practice Address - Country:US
Practice Address - Phone:817-690-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT112530225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist