Healthcare Provider Details

I. General information

NPI: 1861972887
Provider Name (Legal Business Name): DANIEL B RUIZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 HARMONY HLS
BULVERDE TX
78070-2107
US

IV. Provider business mailing address

607 OLIVIA DL
SAN ANTONIO TX
78260-4307
US

V. Phone/Fax

Practice location:
  • Phone: 830-438-1276
  • Fax:
Mailing address:
  • Phone: 210-438-3182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2041846
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: