Provider Demographics
NPI:1245380153
Name:RUETER, BRUCE ALAN (PT, ATC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALAN
Last Name:RUETER
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12697 SWOVELAND RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47346-9669
Mailing Address - Country:US
Mailing Address - Phone:765-751-4825
Mailing Address - Fax:765-751-1124
Practice Address - Street 1:8150 OAKLANDON RD
Practice Address - Street 2:SUITE 111
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9525
Practice Address - Country:US
Practice Address - Phone:317-823-8400
Practice Address - Fax:317-823-8402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002076A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist