Healthcare Provider Details

I. General information

NPI: 1073556478
Provider Name (Legal Business Name): BROOKE BOWER RUGGLES DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 SOMERSET DR
CHARLOTTE NC
28209-1436
US

IV. Provider business mailing address

3008 SOMERSET DR
CHARLOTTE NC
28209-1436
US

V. Phone/Fax

Practice location:
  • Phone: 704-258-4801
  • Fax:
Mailing address:
  • Phone: 704-258-4801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9239
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: