Provider Demographics
NPI:1154398444
Name:TANDOG, RUEL ROY (PT)
Entity type:Individual
Prefix:MR
First Name:RUEL
Middle Name:ROY
Last Name:TANDOG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2500 N RAINBOW BLVD
Mailing Address - Street 2:APT 1018
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4539
Mailing Address - Country:US
Mailing Address - Phone:702-658-9654
Mailing Address - Fax:702-658-9654
Practice Address - Street 1:2881 BUSINESS PARK CT
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9018
Practice Address - Country:US
Practice Address - Phone:702-869-6978
Practice Address - Fax:702-869-6959
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV1971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist