Provider Demographics
NPI:1548927833
Name:RUIZ, ROBERT JAY (PTA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAY
Last Name:RUIZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 W BROADWAY RD APT 2014
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-8461
Mailing Address - Country:US
Mailing Address - Phone:928-216-0941
Mailing Address - Fax:
Practice Address - Street 1:10165 E HAMPTON AVE STE 111
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3327
Practice Address - Country:US
Practice Address - Phone:480-354-5424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-014396225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant