Provider Demographics
NPI:1922157916
Name:RUBY, SCOTT ALAN (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:RUBY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 NE BUTLER MARKET RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1587
Mailing Address - Country:US
Mailing Address - Phone:541-382-9268
Mailing Address - Fax:541-382-6497
Practice Address - Street 1:2565 NE BUTLER MARKET RD STE 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1587
Practice Address - Country:US
Practice Address - Phone:541-382-9268
Practice Address - Fax:541-382-6497
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277850Medicaid
OR130238Medicare PIN