Healthcare Provider Details

I. General information

NPI: 1588730832
Provider Name (Legal Business Name): TAMMY JEANNE RUGGIERI PT, LATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NEWPORT AVE STE C
RUMFORD RI
02916-2070
US

IV. Provider business mailing address

20 SUZANNE CT
WEST GREENWICH RI
02817-2204
US

V. Phone/Fax

Practice location:
  • Phone: 401-435-4540
  • Fax:
Mailing address:
  • Phone: 401-397-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT01398
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: