MEDICARE: PATRICIA RUCKI

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	261QP2000X	Physical Therapy Clinic/Center	PTA21316	FL

General Provider Information

NPI Number	:	1518416189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA RUCKI

Provider Business Mailing Address
First Line	:	3409 COVE CT W
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-5062
Country	:	US
Telephone Number	:	863-604-1055
Fax Number	:

Provider Business Practice Location Address
First Line	:	3409 COVE CT W
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-5062
Country	:	US
Telephone Number	:	863-604-1055
Fax Number	:

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

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	09/23/2016

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Directions to “ PATRICIA RUCKI ” Practice Location

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