Provider Demographics
NPI:1821066101
Name:RUZICH, JON J (PT)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:J
Last Name:RUZICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 E IRONWOOD ST BLDG 2301
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85707-4249
Mailing Address - Country:US
Mailing Address - Phone:520-228-8694
Mailing Address - Fax:
Practice Address - Street 1:5200 E IRONWOOD ST BLDG 2301
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707-4249
Practice Address - Country:US
Practice Address - Phone:520-228-8694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013996L225100000X
PADAPT000848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
001423212OtherHIGHMARK BC/BS
3626933OtherAETNA
4489055OtherCIGNA