Provider Demographics
NPI:1134531940
Name:RUECKERT, CORY WILLIAM (ATC, CES, PES)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:WILLIAM
Last Name:RUECKERT
Suffix:
Gender:M
Credentials:ATC, CES, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16B LAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-1235
Mailing Address - Country:US
Mailing Address - Phone:304-382-4811
Mailing Address - Fax:
Practice Address - Street 1:16B LAYNE AVE
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-1235
Practice Address - Country:US
Practice Address - Phone:304-382-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer