Healthcare Provider Details

I. General information

NPI: 1891552212
Provider Name (Legal Business Name): MICHAEL RUGGERI MS, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4703 E INDIAN SCHOOL RD
PHOENIX AZ
85018-5497
US

IV. Provider business mailing address

26418 N ARROYO WAY
RIO VERDE AZ
85263-7000
US

V. Phone/Fax

Practice location:
  • Phone: 480-484-6300
  • Fax:
Mailing address:
  • Phone: 314-605-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: