MEDICARE: MICHELLE RURA M.S., ATC

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	174400000X	Specialist	AT 003594	OH

General Provider Information

NPI Number	:	1417498577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RURA M.S., ATC

Provider Business Mailing Address
First Line	:	3763 LAKE RUN BLVD
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-4339
Country	:	US
Telephone Number	:	330-727-5960
Fax Number	:

Provider Business Practice Location Address
First Line	:	3763 LAKE RUN BLVD
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-4339
Country	:	US
Telephone Number	:	330-727-5960
Fax Number	:

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

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	03/09/2017

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