MEDICARE: JACQUELINE RUEDA 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	225100000X	Physical Therapist	4344	TN

General Provider Information

NPI Number	:	1710910187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE RUEDA PT.

Provider Business Mailing Address
First Line	:	6231 RAVENWOOD CV
Second Line	:
City	:	HORN LAKE
State	:	MS
Zip	:	38637-2588
Country	:	US
Telephone Number	:	901-438-8799
Fax Number	:	662-280-3324

Provider Business Practice Location Address
First Line	:	6231 RAVENWOOD CV
Second Line	:
City	:	HORN LAKE
State	:	MS
Zip	:	38637-2588
Country	:	US
Telephone Number	:	901-438-8799
Fax Number	:	662-280-3324

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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Directions to “ JACQUELINE RUEDA PT.” Practice Location

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