Provider Demographics
NPI:1245687656
Name:RUIZ, GERARDO OCTAVIO (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:OCTAVIO
Last Name:RUIZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-6414
Mailing Address - Country:US
Mailing Address - Phone:409-722-1485
Mailing Address - Fax:
Practice Address - Street 1:6767 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6414
Practice Address - Country:US
Practice Address - Phone:409-722-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1221559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist