Healthcare Provider Details

I. General information

NPI: 1578701298
Provider Name (Legal Business Name): JILL ELLEN RUGGIERI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST
PHILADELPHIA PA
19107-4824
US

IV. Provider business mailing address

889 N STILLMAN ST
PHILADELPHIA PA
19130-1837
US

V. Phone/Fax

Practice location:
  • Phone: 609-915-8205
  • Fax:
Mailing address:
  • Phone: 609-915-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017805
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: