Provider Demographics
NPI:1154813616
Name:RUCKER, BOBBI (DPT)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 CHEAT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-0022
Mailing Address - Country:US
Mailing Address - Phone:304-594-2500
Mailing Address - Fax:304-594-9310
Practice Address - Street 1:2195 CHEAT RD STE 1
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-0022
Practice Address - Country:US
Practice Address - Phone:304-594-2500
Practice Address - Fax:304-594-9310
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT003989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist