Healthcare Provider Details

I. General information

NPI: 1225142631
Provider Name (Legal Business Name): RICHARD G RUOTI PH D; PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E DESERT INN RD
LAS VEGAS NV
89169-3250
US

IV. Provider business mailing address

790 REMINTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-1501
  • Fax: 702-735-1875
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00255IL
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1954
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: