Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 27413 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | 27413 | CA |
NPI | 1083889711 |
---|---|
Provider Name | Mary Ellen Ruiz Papin |
First Address | Henderson, NV 89074-7631 |
Second Address | Henderson, NV 89074-7631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 15/12/2015 |