Healthcare Provider Details

I. General information

NPI: 1356047864
Provider Name (Legal Business Name): HAILEY RUGGLES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 VALLEY COMMONS DR STE 101
BOZEMAN MT
59718-4531
US

IV. Provider business mailing address

4515 VALLEY COMMONS DR STE 101
BOZEMAN MT
59718-4531
US

V. Phone/Fax

Practice location:
  • Phone: 406-404-1897
  • Fax: 406-404-1899
Mailing address:
  • Phone: 406-404-1897
  • Fax: 406-404-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTP-PT-LIC-24839
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: