Provider Demographics
NPI:1881039196
Name:RUCH, KIM NANCY
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:NANCY
Last Name:RUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ANDREAS
Mailing Address - State:PA
Mailing Address - Zip Code:18211-3138
Mailing Address - Country:US
Mailing Address - Phone:570-386-4208
Mailing Address - Fax:
Practice Address - Street 1:754 PINE HILL RD
Practice Address - Street 2:
Practice Address - City:ANDREAS
Practice Address - State:PA
Practice Address - Zip Code:18211-3138
Practice Address - Country:US
Practice Address - Phone:570-386-4208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000626L225200000X
TEI003785225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant