MEDICARE: MR. JOSEPH PRICE RUGGIERI PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	000726	WV

General Provider Information

NPI Number	:	1497879787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH PRICE RUGGIERI PTA

Provider Business Mailing Address
First Line	:	82 MOON VALLEY RD
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-4826
Country	:	US
Telephone Number	:	304-291-8066
Fax Number	:

Provider Business Practice Location Address
First Line	:	1543 COUNTRY CLUB RD
Second Line	:
City	:	FAIRMONT
State	:	WV
Zip	:	26554-1306
Country	:	US
Telephone Number	:	304-363-4599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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