Provider Demographics
NPI:1952771792
Name:RUANE FAMILY PARTNERSHIP
Entity Type:Organization
Organization Name:RUANE FAMILY PARTNERSHIP
Other - Org Name:SUNNYSIDE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:RUANE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:805-528-2590
Mailing Address - Street 1:1320 VAN BEURDEN DR #103
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3381
Mailing Address - Country:US
Mailing Address - Phone:805-528-2590
Mailing Address - Fax:805-528-2590
Practice Address - Street 1:1320 VAN BEURDEN DR #103
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3381
Practice Address - Country:US
Practice Address - Phone:805-528-2590
Practice Address - Fax:805-528-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CAPT 25012261QP2000X
CAPT 25006261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy