Healthcare Provider Details

I. General information

NPI: 1710898747
Provider Name (Legal Business Name): BENJAMIN RUETENIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE STE 1301
MIAMI FL
33136-1003
US

IV. Provider business mailing address

4712 SW 67TH AVE APT G10
MIAMI FL
33155-5815
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-1013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT39055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: