Healthcare Provider Details

I. General information

NPI: 1457287898
Provider Name (Legal Business Name): ARYEL RUCKDASCHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GRANT AVE
OMRO WI
54963-1342
US

IV. Provider business mailing address

414 8TH ST NE
STAPLES MN
56479-3015
US

V. Phone/Fax

Practice location:
  • Phone: 920-252-0796
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberW833282656214
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: