Provider Demographics
NPI:1144646308
Name:RUEDAS, LUZ (PT)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:RUEDAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4607 MANCHACA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1607
Mailing Address - Country:US
Mailing Address - Phone:512-916-1511
Mailing Address - Fax:512-916-1532
Practice Address - Street 1:4607 MANCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1607
Practice Address - Country:US
Practice Address - Phone:512-916-1511
Practice Address - Fax:512-916-1532
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1224501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist