Provider Demographics
NPI:1134274111
Name:RUIZ, KAREN FRANCES (PT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:FRANCES
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9535 LEAMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1235
Mailing Address - Country:US
Mailing Address - Phone:847-679-5730
Mailing Address - Fax:
Practice Address - Street 1:1159 WILMETTE AVE STE 9
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2652
Practice Address - Country:US
Practice Address - Phone:847-251-1539
Practice Address - Fax:847-251-1539
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001622245OtherBLUE CROSS BLUE SHIELD
IL211566Medicare ID - Type UnspecifiedPROVIDER #