MEDICARE: RUIZ PHYSICAL THERAPY

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	CA6820	CA

General Provider Information

NPI Number	:	1649394651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUIZ PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	5308 DERRY AVE
Second Line	:	UNIT K
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4530
Country	:	US
Telephone Number	:	831-373-7222
Fax Number	:	818-594-3348

Provider Business Practice Location Address
First Line	:	5308 DERRY AVE
Second Line	:	UNIT K
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4530
Country	:	US
Telephone Number	:	831-373-7222
Fax Number	:	818-594-3348

Authorized Official
Title or Position	:	OWNER
Name	:	TERESA RAMAPRIYA RUIZ
Credential	:	P.T.
Telephone Number	:	831-373-7222

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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