Organization
WHITE TANKS PHYSICAL THERAPY AND ORTHOPEDIC REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PABLO RUIZ JR. P.T. (OWNER/PHYSICAL THERAPIST)
(623) 882-9787
Entity
Organization
Contact information
Practice address
250 N LITCHFIELD RD, SUITE 155, GOODYEAR, AZ 85338-1333
(623) 882-9787
Mailing address
250 N LITCHFIELD RD, SUITE 155, GOODYEAR, AZ 85338-1333
(623) 882-9787
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Z2985
HUMANA
—
01
—
3786840000
DEPT. OF LABOR
AZ
01
—
64-0096
EVERCARE AHCCS
AZ
01
—
7499498
AETNA ID
AZ
01
—
AZ0299850
BC/BS OF AZ
AZ
Enumeration date
10/20/2006
Last updated
07/21/2022
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