MEDICARE: ANTHONY JAMES RUIZ LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	20120001317	MN

General Provider Information

NPI Number	:	1255686564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY JAMES RUIZ LMT

Provider Business Mailing Address
First Line	:	2296 CASCADE PLZ N
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55125-1605
Country	:	US
Telephone Number	:	612-354-6625
Fax Number	:	612-437-4801

Provider Business Practice Location Address
First Line	:	1821 SAINT CLAIR AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1642
Country	:	US
Telephone Number	:	612-354-6625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	07/24/2012

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