MEDICARE: JOY MICHELLE RUEDA 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	031775	NY

General Provider Information

NPI Number	:	1265717425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY MICHELLE RUEDA PT

Provider Business Mailing Address
First Line	:	469 FASHION AVE
Second Line	:	SUITE 327-328
City	:	NEW YORK
State	:	NY
Zip	:	10018-7605
Country	:	US
Telephone Number	:	212-359-9592
Fax Number	:	718-775-3419

Provider Business Practice Location Address
First Line	:	3044 CONEY ISLAND AVE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5660
Country	:	US
Telephone Number	:	212-359-9592
Fax Number	:	718-775-3419

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

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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