Provider Demographics
NPI:1255054557
Name:RUYBAL, SHIRLEY ANN (MT)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:RUYBAL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 S JACKSON ST STE 1005
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3809
Mailing Address - Country:US
Mailing Address - Phone:303-756-0360
Mailing Address - Fax:303-484-2860
Practice Address - Street 1:1776 S JACKSON ST STE 1005
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3809
Practice Address - Country:US
Practice Address - Phone:303-756-0360
Practice Address - Fax:303-484-2860
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0006974225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist