Provider Demographics
NPI:1952506974
Name:RUIZ, RAUL RODRIGUEZ (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:RODRIGUEZ
Last Name:RUIZ
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21420
Mailing Address - Street 2:UPR STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00931-1420
Mailing Address - Country:US
Mailing Address - Phone:787-752-7505
Mailing Address - Fax:
Practice Address - Street 1:217 CLAVEL ST.
Practice Address - Street 2:BUZON 632 BO. BUENAVENTURA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-752-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist