Healthcare Provider Details

I. General information

NPI: 1952771792
Provider Name (Legal Business Name): RUANE FAMILY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 VAN BEURDEN DR #103
LOS OSOS CA
93402-3381
US

IV. Provider business mailing address

1320 VAN BEURDEN DR #103
LOS OSOS CA
93402-3381
US

V. Phone/Fax

Practice location:
  • Phone: 805-528-2590
  • Fax: 805-528-2590
Mailing address:
  • Phone: 805-528-2590
  • Fax: 805-528-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 25012
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 25006
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW RUANE
Title or Position: GENERAL PARTNER
Credential: MPT
Phone: 805-528-2590