Provider Demographics
NPI:1073556478
Name:RUGGLES, BROOKE BOWER (DPT)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:BOWER
Last Name:RUGGLES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1436
Mailing Address - Country:US
Mailing Address - Phone:704-258-4801
Mailing Address - Fax:
Practice Address - Street 1:3008 SOMERSET DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1436
Practice Address - Country:US
Practice Address - Phone:704-258-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00323870OtherRAILROAD MEDICARE
P00323870OtherRAILROAD MEDICARE