Provider Demographics
NPI:1538268933
Name:RUGGLES, TRACY R (PT)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:R
Last Name:RUGGLES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:R
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:706-494-3071
Mailing Address - Fax:
Practice Address - Street 1:512 N SHADY LN
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2991
Practice Address - Country:US
Practice Address - Phone:334-255-7179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115572225100000X
TX1144616225100000X
ALPTH6786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist