1912306291 NPI number — MOLLY RUECKER PT, DPT, SCS, ATC

Table of content: MOLLY RUECKER PT, DPT, SCS, ATC (NPI 1912306291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912306291 NPI number — MOLLY RUECKER PT, DPT, SCS, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUECKER
Provider First Name:
MOLLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, SCS, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KORDSMEIER
Provider Other First Name:
MOLLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT, ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912306291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CMR 445 BOX 1346
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09046-0014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TUNISIA PLACE 3112 C5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOBLINGEN-PK
Provider Business Practice Location Address State Name:
EU
Provider Business Practice Location Address Postal Code:
71032
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
813-468-8812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTL0012819 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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