Provider Demographics
NPI:1821284530
Name:RUELAS, BLAS MARCOS (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:BLAS
Middle Name:MARCOS
Last Name:RUELAS
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9745 TOUCHTON RD
Mailing Address - Street 2:UNIT 3105
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4487
Mailing Address - Country:US
Mailing Address - Phone:904-322-1004
Mailing Address - Fax:
Practice Address - Street 1:2800 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3321
Practice Address - Country:US
Practice Address - Phone:904-322-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 21462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer