Provider Demographics
NPI:1194061028
Name:RUCH, DANIEL (PA-C, ATC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:RUCH
Suffix:
Gender:M
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-689-5600
Mailing Address - Fax:757-579-8532
Practice Address - Street 1:2006 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-5600
Practice Address - Fax:757-579-8532
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260013792255A2300X
VA0110005025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194061028Medicaid