Provider Demographics
NPI:1386806560
Name:SILVA-RUEDA, LUZ MIREYA
Entity type:Individual
Prefix:PROF
First Name:LUZ
Middle Name:MIREYA
Last Name:SILVA-RUEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:MIREYA
Other - Last Name:SILVA-RUEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:11301 DESERT GLEN DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8293
Mailing Address - Country:US
Mailing Address - Phone:317-431-1147
Mailing Address - Fax:317-585-0365
Practice Address - Street 1:11301 DESERT GLEN DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-8293
Practice Address - Country:US
Practice Address - Phone:317-431-1147
Practice Address - Fax:317-585-0365
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004633A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200605990OtherRENDERING PROVIDER NUMBER
IN200731600AOtherFIRST STEPS PROVIDER