Provider Demographics
NPI:1851279491
Name:MUNOZ, RUBEN (PTA)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:MUNOZ
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 1:13358 S ROSECREST RD
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-4501
Mailing Address - Country:US
Mailing Address - Phone:801-302-7230
Mailing Address - Fax:801-601-8245
Practice Address - Street 1:4317 N PONY EXPRESS PKWY STE 120
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-1230
Practice Address - Country:US
Practice Address - Phone:801-344-6714
Practice Address - Fax:801-438-7746
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14213001-2401225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant