Provider Demographics
NPI:1407247810
Name:SCRUGGS, RONDALE LESLIE (DPT, PT)
Entity Type:Individual
Prefix:
First Name:RONDALE
Middle Name:LESLIE
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4385 COYOTE CREST CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7814
Mailing Address - Country:US
Mailing Address - Phone:702-581-4380
Mailing Address - Fax:
Practice Address - Street 1:6659 VIRTUOSO CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6712
Practice Address - Country:US
Practice Address - Phone:702-581-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-08
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NV4858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No172V00000XOther Service ProvidersCommunity Health Worker