Provider Demographics
NPI:1992468136
Name:RUVALCABA, PATRICIO (DPT)
Entity Type:Individual
Prefix:
First Name:PATRICIO
Middle Name:
Last Name:RUVALCABA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11911 GREENVILLE AVE APT 2314
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3671
Mailing Address - Country:US
Mailing Address - Phone:915-920-2360
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:11911 GREENVILLE AVE APT 2314
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3671
Practice Address - Country:US
Practice Address - Phone:915-920-2360
Practice Address - Fax:630-928-5080
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1353202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist