Healthcare Provider Details

I. General information

NPI: 1194234591
Provider Name (Legal Business Name): CRAIG RAYMOND RUGGIERO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S DARGAN ST
FLORENCE SC
29506-2559
US

IV. Provider business mailing address

804 LANCELOT DRIVE
FLORENCE SC
29505
US

V. Phone/Fax

Practice location:
  • Phone: 843-669-4403
  • Fax:
Mailing address:
  • Phone: 843-496-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT.3314PT
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: