Provider Demographics
NPI:1689694754
Name:GRUSS, CYNTHIA ALICE (ATC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ALICE
Last Name:GRUSS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ALICE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT AT
Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5213
Mailing Address - Fax:
Practice Address - Street 1:320 WESTERN BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1259
Practice Address - Country:US
Practice Address - Phone:860-657-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
CT009849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer