Provider Demographics
NPI:1730616681
Name:RUGER, ALYSSA MARII (LMT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARII
Last Name:RUGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 DARCY LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915
Mailing Address - Country:US
Mailing Address - Phone:641-494-4539
Mailing Address - Fax:
Practice Address - Street 1:7680 GODDARD ST STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8233
Practice Address - Country:US
Practice Address - Phone:719-502-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019131225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist