Provider Demographics
NPI:1710991609
Name:RUDER, JAYMIE SUANNE (LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JAYMIE
Middle Name:SUANNE
Last Name:RUDER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 E FAIR ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3735
Mailing Address - Country:US
Mailing Address - Phone:620-272-9202
Mailing Address - Fax:
Practice Address - Street 1:101 E FULTON ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5455
Practice Address - Country:US
Practice Address - Phone:620-275-8400
Practice Address - Fax:620-275-2687
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-003002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer