Provider Demographics
NPI:1679651368
Name:RUSCHE, KENNETH R (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:RUSCHE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7567 CENTRAL PARKE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6855
Mailing Address - Country:US
Mailing Address - Phone:513-701-6104
Mailing Address - Fax:
Practice Address - Street 1:7567 CENTRAL PARKE BLVD., STE. D
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OHIO
Practice Address - Zip Code:45040
Practice Address - Country:UM
Practice Address - Phone:513-229-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 02022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0214940Medicaid
OH366632Medicare PIN
OH0214940Medicaid
OH0214940Medicaid