Healthcare Provider Details

I. General information

NPI: 1710948922
Provider Name (Legal Business Name): JOLENE RUWE ATC/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 CHEVIOT RD
CINCINNATI OH
45247-7006
US

IV. Provider business mailing address

10390 HOWARD RD
HARRISON OH
45030-9511
US

V. Phone/Fax

Practice location:
  • Phone: 513-741-4700
  • Fax: 513-741-4712
Mailing address:
  • Phone: 513-637-0644
  • Fax: 513-741-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number992936
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: