Provider Demographics
NPI:1548024227
Name:RUIZ, JOSE ALBERTO (LMT)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ALBERTO
Last Name:RUIZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 E ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-6711
Mailing Address - Country:US
Mailing Address - Phone:321-438-7029
Mailing Address - Fax:
Practice Address - Street 1:2111 E MICHIGAN ST STE 202
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4973
Practice Address - Country:US
Practice Address - Phone:321-438-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA85227225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist