Individual
MATTHEW MARK RUECKERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
605 WASHINGTON ST, FAYETTE, IA 52142-9206
(563) 425-5364
(563) 425-5334
Mailing address
701 JEFFERSON ST, WEST UNION, IA 52175-9553
(563) 422-6057
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
00375
IA
Other
Enumeration date
03/21/2007
Last updated
07/08/2007
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