Provider Demographics
NPI:1639788748
Name:RUEKERT, AMANDA (PT, DPT, CMTPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:RUEKERT
Suffix:
Gender:F
Credentials:PT, DPT, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21700 INTERTECH DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5197
Mailing Address - Country:US
Mailing Address - Phone:262-532-8300
Mailing Address - Fax:
Practice Address - Street 1:21700 INTERTECH DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5197
Practice Address - Country:US
Practice Address - Phone:262-532-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13460-24208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation