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General NPI Number Information
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NPI Number | 1679232102
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Entity Type | Individual
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Provider Name | MATTHEW RUGGLES
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Gender | Male
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 8543 WINCHESTER AVE
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City | INWOOD
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State | WV
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Zip | 25428-4022
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Country | US
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Telephone | 304-229-1010
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 527
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City | INWOOD
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State | WV
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Zip | 25428-0527
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Country | US
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Telephone | 304-359-3356
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA002053
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License Number State | WV
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