Healthcare Provider Details

I. General information

NPI: 1922477751
Provider Name (Legal Business Name): MATTHEW RUANE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 LOS OSOS VALLEY RD
LOS OSOS CA
93402-3237
US

IV. Provider business mailing address

1315 5TH ST
LOS OSOS CA
93402-1210
US

V. Phone/Fax

Practice location:
  • Phone: 805-528-2590
  • Fax:
Mailing address:
  • Phone: 805-528-5344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 25012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: