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General NPI Number Information
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NPI Number | 1669812012
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Entity Type | Individual
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Provider Name | JESSICA RUGE LEGGETT D.P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2013
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 2756 US HIGHWAY 64 E
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City | PLYMOUTH
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State | NC
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Zip | 27962-8903
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Country | US
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Telephone | 703-615-9351
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1181
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City | WILLIAMSTON
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State | NC
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Zip | 27892-1181
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Country | US
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Telephone | 703-615-9351
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 2305205582
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License Number State | VA
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