Provider Demographics
NPI:1922131440
Name:RUCKER, REBECCA SARA (DPT, OCS, CSCS)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SARA
Last Name:RUCKER
Suffix:
Gender:F
Credentials:DPT, OCS, CSCS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:THORNDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:7719 64TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5515
Mailing Address - Country:US
Mailing Address - Phone:253-200-0741
Mailing Address - Fax:
Practice Address - Street 1:7719 64TH AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5515
Practice Address - Country:US
Practice Address - Phone:253-200-0741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000089042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7121973Medicaid
WA0193067OtherL&I
WA7121973Medicaid