MEDICARE: ALYSSA MARII RUGER LMT

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	0019131	CO

General Provider Information

NPI Number	:	1730616681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MARII RUGER LMT

Provider Business Mailing Address
First Line	:	5548 DARCY LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915
Country	:	US
Telephone Number	:	641-494-4539
Fax Number	:

Provider Business Practice Location Address
First Line	:	7680 GODDARD ST STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8233
Country	:	US
Telephone Number	:	719-502-9779
Fax Number	:

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

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	05/22/2017

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