Provider Demographics
NPI:1154481521
Name:RUICH, CYNTHIA (MPT)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:RUICH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:LOUISE
Other - Last Name:SPIETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11143 PARKVIEW PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1728
Practice Address - Country:US
Practice Address - Phone:260-266-7400
Practice Address - Fax:260-266-7439
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002010A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100357810AMedicaid
IN1424OtherPHP
IN4423623OtherAETNA
IN35179001202OtherCARESOURCE
IN000000491118OtherANTHEM BCBS
IN1424OtherPHP