Provider Demographics
NPI:1194333484
Name:RUCKES, REBBECCA ALISTER (ATC, LAT)
Entity type:Individual
Prefix:
First Name:REBBECCA
Middle Name:ALISTER
Last Name:RUCKES
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 COUNTY ROAD 503
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-8488
Mailing Address - Country:US
Mailing Address - Phone:662-587-0699
Mailing Address - Fax:
Practice Address - Street 1:741 CR 503
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-3866
Practice Address - Country:US
Practice Address - Phone:662-587-0699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT08402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer