Healthcare Provider Details

I. General information

NPI: 1376698514
Provider Name (Legal Business Name): RUBY MOUNTAIN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 IDAHO ST STE 101
ELKO NV
89801-2635
US

IV. Provider business mailing address

1910 IDAHO ST STE 101
ELKO NV
89801-2635
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-7722
  • Fax: 775-777-7900
Mailing address:
  • Phone: 775-777-7722
  • Fax: 775-777-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONYCA L JENSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 775-423-5233