Provider Demographics
NPI:1235400201
Name:RUEACH, AMANDA DAWN (MED, ATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:RUEACH
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 ELIM AVE
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-3214
Mailing Address - Country:US
Mailing Address - Phone:847-246-7464
Mailing Address - Fax:
Practice Address - Street 1:305 WEST WACKER DRIVE
Practice Address - Street 2:SUITE 1020
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606
Practice Address - Country:US
Practice Address - Phone:312-640-0329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI096.0026302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer