Provider Demographics
NPI:1912306291
Name:RUECKER, MOLLY (PT, DPT, SCS, ATC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:RUECKER
Suffix:
Gender:F
Credentials:PT, DPT, SCS, ATC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:KORDSMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:CMR 445 BOX 1346
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09046-0014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:TUNISIA PLACE 3112 C5
Practice Address - Street 2:
Practice Address - City:BOBLINGEN-PK
Practice Address - State:EU
Practice Address - Zip Code:71032
Practice Address - Country:DE
Practice Address - Phone:813-468-8812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0012819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist