MEDICARE: MRS. AUDRA MJ RUFFIN CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0019005071	VA

General Provider Information

NPI Number	:	1366638942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUDRA MJ RUFFIN CMT

Provider Business Mailing Address
First Line	:	4006 NORBORNE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-1314
Country	:	US
Telephone Number	:	804-421-7644
Fax Number	:	804-421-7644

Provider Business Practice Location Address
First Line	:	4006 NORBORNE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-1314
Country	:	US
Telephone Number	:	804-421-7644
Fax Number	:	804-421-7644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	09/18/2007

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