Provider Demographics
NPI:1225439235
Name:RUEDEN, KAELA E (PT)
Entity Type:Individual
Prefix:MS
First Name:KAELA
Middle Name:E
Last Name:RUEDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KAELA
Other - Middle Name:
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 PLOVER RD
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-3916
Mailing Address - Country:US
Mailing Address - Phone:715-295-3950
Mailing Address - Fax:
Practice Address - Street 1:2401 PLOVER RD
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-3916
Practice Address - Country:US
Practice Address - Phone:715-295-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12818-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12818-24OtherWISCONSIN PT LICENSE