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General NPI Number Information
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NPI Number | 1023695970
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Entity Type | Organization
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Legal Business Name | RUKI & LT LLC
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 10 THE BLVD
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City | NEWNAN
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State | GA
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Zip | 30263-6282
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Country | US
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Telephone | 513-781-9650
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Fax |
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Provider Business Mailing Address
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Address Line | 124 MORGAN ST
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City | LAGRANGE
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State | GA
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Zip | 30240
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Country | US
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Telephone | 513-781-9650
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Fax |
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Authorized Official
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Title or Position | ADMINISTOR
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Name | NICASIO JONES
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Credential |
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Telephone | 813-458-8858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0404X
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Taxonomy Name | Cardiac Rehabilitation Clinic/Center
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License Number |
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License Number State |
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