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1225142631

NPI Code Detail

MEDICARE: DR. RICHARD G RUOTI PH D; PT

MEDICARE: DR. RICHARD G RUOTI PH D; PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00255IL	PA
2	225100000X	Physical Therapist	1954	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0002885	OTHER		AETNA (HMO)
2	232088952	OTHER		TRI-CARE
3	50014014	OTHER		CAPITAL BLUE CROSS
4	122262	OTHER	PA	HIGHMARK BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0023832000	OTHER	PA	INDEPENDENCE BLUE CROSS
7	5635441	OTHER		AETNA (PPO)
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225142631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD G RUOTI PH D; PT

Provider Business Mailing Address
First Line	:	790 REMINTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	1950 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3250
Country	:	US
Telephone Number	:	702-735-1501
Fax Number	:	702-735-1875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/30/2015

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Directions to “ DR. RICHARD G RUOTI PH D; PT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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