Provider Demographics
NPI:1437720869
Name:RUCKER, HEATHER (DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3795 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2036
Mailing Address - Country:US
Mailing Address - Phone:191-328-6042
Mailing Address - Fax:844-380-0832
Practice Address - Street 1:3795 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66206-2036
Practice Address - Country:US
Practice Address - Phone:191-328-6042
Practice Address - Fax:844-380-0832
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06796261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy