Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05008949A | IN |
N | 2251E1300X | Electrophysiology, Clinical | 05008949A | IN |
N | 2251E1300X | Electrophysiology, Clinical | 5501012113 | MI |
N | 2251X0800X | Physical Therapist - Orthopedic | 5501012113 | MI |
NPI | 1013907500 |
---|---|
Provider Name | Dr. Thomas M Ruediger |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-1728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 24/12/2020 |