Provider Demographics
NPI:1376187864
Name:RAGSDALE, ROBERT III (ATC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RAGSDALE
Suffix:III
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 LAKEWOOD DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-3017
Mailing Address - Country:US
Mailing Address - Phone:731-415-0538
Mailing Address - Fax:
Practice Address - Street 1:601 TIGER DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-1946
Practice Address - Country:US
Practice Address - Phone:662-563-4756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT07902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer