Active NPI
Shaun M Ruckman, PT
- Physical Therapist
- Surprise, AZ
National Provider Identifier
1871803320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 9056
- Practice address
- 15543 N Reems Rd
Suite133
Surprise, AZ 85374-9582 - Phone
- (623) 975-5374
- Fax
- (623) 214-9489
- NPI assigned
- Oct 18, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9056 | AZ | Primary |
| Sports Physical Therapist | 2251S0007X | |||
| Orthopedic Physical Therapist | 2251X0800X |
Addresses
Primary practice location
15543 N Reems Rd
Suite133
Surprise, AZ 85374-9582
Mailing address
15543 N Reems Rd
Suite133
Surprise, AZ 85374-9582
Phone (623) 975-5374
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9056 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287532800000",
"number": "1871803320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15543 N REEMS RD",
"address_2": "SUITE133",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853749582",
"telephone_number": "623-975-5374",
"fax_number": "623-214-9489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15543 N REEMS RD",
"address_2": "SUITE133",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853749582",
"telephone_number": "623-975-5374",
"fax_number": "623-214-9489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUCKMAN",
"first_name": "SHAUN",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-10-18",
"last_updated": "2010-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "9056",
"primary": true
},
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": null,
"license": null,
"primary": false
},
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Surprise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.