Provider Demographics
NPI:1063883866
Name:RUIZ, JESSICA MARIE A (PT, DPT, LMT, GTS)
Entity type:Individual
Prefix:DR
First Name:JESSICA MARIE
Middle Name:A
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PT, DPT, LMT, GTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-1057 AINAMAKUA DR.
Mailing Address - Street 2:SUITE F-11
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789
Mailing Address - Country:US
Mailing Address - Phone:808-597-1005
Mailing Address - Fax:808-657-3222
Practice Address - Street 1:95-1057 AINAMAKUA DR.
Practice Address - Street 2:SUITE F-11
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789
Practice Address - Country:US
Practice Address - Phone:808-597-1005
Practice Address - Fax:808-657-3222
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-14437225700000X
HIPT-6057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist