Provider Demographics
NPI:1992469522
Name:RUEBUSH, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:RUEBUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 TETON RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62326-1611
Mailing Address - Country:US
Mailing Address - Phone:309-221-9888
Mailing Address - Fax:
Practice Address - Street 1:630 LOCUST ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321-1459
Practice Address - Country:US
Practice Address - Phone:217-354-6560
Practice Address - Fax:217-357-6561
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.020071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist