Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1013572171 |
---|---|
Provider Name | Ernestine Ruvuza |
First Address | Toledo, OH 43617-3114 |
Second Address | Toledo, OH 43617-3114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2019 |
Last Update Date | 04/05/2019 |