Healthcare Provider Details

I. General information

NPI: 1235978479
Provider Name (Legal Business Name): CARLA MARILYN RUGGLES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLY MARILYN RUGGLES

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 OHLONE PKWY STE D
WATSONVILLE CA
95076-3767
US

IV. Provider business mailing address

4636 194TH AVE SE
ISSAQUAH WA
98027-9357
US

V. Phone/Fax

Practice location:
  • Phone: 831-724-8235
  • Fax:
Mailing address:
  • Phone: 425-677-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number307532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: