Individual
MR. MITCHELL S. RUIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
9555 76TH ST, PLEASANT PRAIRIE, WI 53158-1984
(262) 577-8989
(262) 577-8990
Mailing address
N2020 COUNTY ROAD H LOT 536, LAKE GENEVA, WI 53147-4702
(262) 248-1359
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1267-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40468500
—
WI
Enumeration date
04/10/2007
Last updated
07/08/2007
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