Provider Demographics
NPI:1144599069
Name:RUIZ, DOREEN MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:MICHELLE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532127
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-2127
Mailing Address - Country:US
Mailing Address - Phone:830-757-2494
Mailing Address - Fax:830-757-0489
Practice Address - Street 1:1801 N ED CAREY DR
Practice Address - Street 2:SUITE C
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8268
Practice Address - Country:US
Practice Address - Phone:830-757-2497
Practice Address - Fax:830-757-0489
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1213186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB146762Medicare PIN