Provider Demographics
NPI:1003327438
Name:RUYBALID, IAN SEAN (DPT)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:SEAN
Last Name:RUYBALID
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 1:2116 VISTA OESTE NW BLDG 3A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4340
Mailing Address - Country:US
Mailing Address - Phone:505-895-9353
Mailing Address - Fax:
Practice Address - Street 1:2116 VISTA OESTE NW BLDG 3A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4340
Practice Address - Country:US
Practice Address - Phone:505-895-9353
Practice Address - Fax:505-212-0786
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT-2024-02712251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic