Healthcare Provider Details

I. General information

NPI: 1023874823
Provider Name (Legal Business Name): JANE RUGE PT, DPT, PCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 GREENWAY DR
BLOOMINGDALE IL
60108-2026
US

IV. Provider business mailing address

22W600 BUTTERFIELD RD
GLEN ELLYN IL
60137-6901
US

V. Phone/Fax

Practice location:
  • Phone: 630-351-3416
  • Fax:
Mailing address:
  • Phone: 630-942-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070013593
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: