Provider Demographics
NPI:1770533812
Name:WANCA, RUTH ELLEN (PT)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:WANCA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ELLEN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7200 W BELL RD
Mailing Address - Street 2:SUITE F-101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8529
Mailing Address - Country:US
Mailing Address - Phone:623-776-9111
Mailing Address - Fax:623-776-9115
Practice Address - Street 1:18700 N 64RTH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:602-512-8623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-001726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109219Medicare PIN