Provider Demographics
NPI:1922694330
Name:RUE, CARLOS BRIAN (ATC/L)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:BRIAN
Last Name:RUE
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8313 S BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5747
Mailing Address - Country:US
Mailing Address - Phone:520-360-6454
Mailing Address - Fax:
Practice Address - Street 1:4101 E VALENCIA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-5096
Practice Address - Country:US
Practice Address - Phone:520-545-5251
Practice Address - Fax:520-545-5116
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer