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General NPI Number Information
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NPI Number | 1710352653
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Entity Type | Individual
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Provider Name | KYLE RUHDE ATC
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Gender | Male
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | 645 SUNRISE DR
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City | SOMERSET
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State | WI
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Zip | 54025
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Country | US
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Telephone | 715-312-0608
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Fax |
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Provider Business Mailing Address
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Address Line | 6949 LAKEVIEW RD
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City | SIREN
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State | WI
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Zip | 54872-9015
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Country | US
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Telephone | 715-312-0608
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1765
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License Number State | MN
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