Healthcare Provider Details

I. General information

NPI: 1649437013
Provider Name (Legal Business Name): JACQUELYN MARIE RUEN DPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 MINNEHAHA AVE W STE 100
SAINT PAUL MN
55104-1033
US

IV. Provider business mailing address

7581 9TH ST N STE 100
OAKDALE MN
55128-6635
US

V. Phone/Fax

Practice location:
  • Phone: 651-348-7428
  • Fax: 651-348-7432
Mailing address:
  • Phone: 651-748-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9265
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number09309
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number012636
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9265
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: