Provider Demographics
NPI:1295805307
Name:RUINEN, M LOUISE (MSPT)
Entity type:Individual
Prefix:
First Name:M
Middle Name:LOUISE
Last Name:RUINEN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SHERMAN HILL RD
Mailing Address - Street 2:A-201
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3648
Mailing Address - Country:US
Mailing Address - Phone:203-263-3104
Mailing Address - Fax:203-263-4050
Practice Address - Street 1:51 SHERMAN HILL RD
Practice Address - Street 2:A-201
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3648
Practice Address - Country:US
Practice Address - Phone:203-263-3104
Practice Address - Fax:203-263-4050
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0021862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002186OtherSTATE LICENSE NUMBER