MEDICARE: DR. THOMAS M RUEDIGER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251E1300X	Clinical Electrophysiology Physical Therapist	05008949A	IN
2	2251E1300X	Clinical Electrophysiology Physical Therapist	5501012113	MI
3	2251X0800X	Orthopedic Physical Therapist	5501012113	MI
4	225100000X	Physical Therapist	05008949A	IN

General Provider Information

NPI Number	:	1013907500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS M RUEDIGER PT

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11143 PARKVIEW PLAZA DR STE 100
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1728
Country	:	US
Telephone Number	:	260-266-7400
Fax Number	:	260-266-7439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	12/24/2020

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