Healthcare Provider Details

I. General information

NPI: 1528391919
Provider Name (Legal Business Name): JODY ANGELA RUGGLES LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODY ANGELA ASHE LMP

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10709 N DIVISION ST
SPOKANE WA
99218-1631
US

IV. Provider business mailing address

11404 E ANTLER RD
CHATTAROY WA
99003-9721
US

V. Phone/Fax

Practice location:
  • Phone: 509-466-9008
  • Fax:
Mailing address:
  • Phone: 509-714-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60110066
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: