Provider Demographics
NPI:1386806255
Name:RUGOTZKE, JOHN DAVID (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:RUGOTZKE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 SHEPARD ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3552
Mailing Address - Country:US
Mailing Address - Phone:715-365-5252
Mailing Address - Fax:715-365-5258
Practice Address - Street 1:586 SHEPARD ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3552
Practice Address - Country:US
Practice Address - Phone:715-365-5252
Practice Address - Fax:715-365-5258
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11057-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist