Provider Demographics
NPI:1962787481
Name:RUIZ, CATHERINE LACSAMANA (PT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LACSAMANA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1432
Mailing Address - Country:US
Mailing Address - Phone:516-223-8286
Mailing Address - Fax:
Practice Address - Street 1:870 WESLEY ST
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1432
Practice Address - Country:US
Practice Address - Phone:516-223-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist