Healthcare Provider Details

I. General information

NPI: 1710760525
Provider Name (Legal Business Name): MARY NICOLE RUGGIERI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 BAILEY LN STE 111
NAPLES FL
34105-8506
US

IV. Provider business mailing address

11466 SUMTER GROVE WAY UNIT 9111
NAPLES FL
34113-8889
US

V. Phone/Fax

Practice location:
  • Phone: 239-431-9650
  • Fax:
Mailing address:
  • Phone: 216-870-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT40627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: