Provider Demographics
NPI:1548620735
Name:KADISH, EMILY RUCKER (DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RUCKER
Last Name:KADISH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:RUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10857 GLENHURST ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8559
Mailing Address - Country:US
Mailing Address - Phone:304-654-2822
Mailing Address - Fax:239-334-7070
Practice Address - Street 1:10857 GLENHURST ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8559
Practice Address - Country:US
Practice Address - Phone:304-654-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist