MEDICARE: MATTHEW RUANE 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	PT 25012	CA

General Provider Information

NPI Number	:	1922477751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW RUANE PT

Provider Business Mailing Address
First Line	:	1315 5TH ST
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-1210
Country	:	US
Telephone Number	:	805-528-5344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1072 LOS OSOS VALLEY RD
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-3237
Country	:	US
Telephone Number	:	805-528-2590
Fax Number	:

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

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	09/23/2015

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Directions to “ MATTHEW RUANE PT” Practice Location

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