Provider Demographics
NPI:1679787048
Name:RUTA, MARIAN CUBA (DPT)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:CUBA
Last Name:RUTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:CUBA
Other - Last Name:RUTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:6278 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4119
Mailing Address - Country:US
Mailing Address - Phone:240-750-9966
Mailing Address - Fax:301-299-2389
Practice Address - Street 1:6278 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4119
Practice Address - Country:US
Practice Address - Phone:240-750-9966
Practice Address - Fax:301-299-2382
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18214174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF8297OtherNATIONAL CAPITAL
MD565601000Medicaid
MDKH49ADOtherBCBS MD
MD490226Medicare ID - Type UnspecifiedPROVIDER NUMBER