Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 017793-1 | NY |
N | 2251G0304X | Physical Therapist - Geriatrics | 017793-1 | NY |
NPI | 1215162615 |
---|---|
Provider Name | Mary Joy Ruiz |
First Address | Flushing, NY 11354-1239 |
Second Address | Bronx, NY 10461-4621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2009 |
Last Update Date | 06/07/2010 |