Provider Demographics
NPI:1215136213
Name:RUEDA, MYA ANN SWAN (DPT)
Entity type:Individual
Prefix:
First Name:MYA
Middle Name:ANN SWAN
Last Name:RUEDA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16044 S 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85045-1752
Mailing Address - Country:US
Mailing Address - Phone:602-206-8261
Mailing Address - Fax:602-206-8261
Practice Address - Street 1:16515 S 40TH ST
Practice Address - Street 2:SUITE 133
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0558
Practice Address - Country:US
Practice Address - Phone:602-206-8261
Practice Address - Fax:602-206-8261
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65722251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic