Healthcare Provider Details

I. General information

NPI: 1912367293
Provider Name (Legal Business Name): RYAN BUGNI PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 E BIG BEAVER RD STE 200
TROY MI
48083-2015
US

IV. Provider business mailing address

1819 E BIG BEAVER RD STE 200
TROY MI
48083-2015
US

V. Phone/Fax

Practice location:
  • Phone: 248-619-1733
  • Fax: 248-619-1744
Mailing address:
  • Phone: 248-619-1733
  • Fax: 248-619-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502004841
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: