Healthcare Provider Details

I. General information

NPI: 1255245361
Provider Name (Legal Business Name): KRISTIANA T RUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 PHOENIX MILLS RD
COOPERSTOWN NY
13326-5716
US

IV. Provider business mailing address

88 PIONEER ST APT 1
COOPERSTOWN NY
13326-1277
US

V. Phone/Fax

Practice location:
  • Phone: 607-544-2600
  • Fax:
Mailing address:
  • Phone: 347-912-5692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number042085-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: