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General NPI Number Information
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NPI Number | 1538268933
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Entity Type | Individual
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Provider Name | TRACY R. RUGGLES P.T.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 512 N SHADY LN
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City | DOTHAN
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State | AL
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Zip | 36303-2991
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Country | US
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Telephone | 334-255-7179
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 370
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City | FORTSON
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State | GA
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Zip | 31808-0370
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Country | US
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Telephone | 706-494-3071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 115572
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1144616
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH6786
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License Number State | AL
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