Provider Demographics
NPI:1528184074
Name:RUFFNER, MISTY ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:ANN
Last Name:RUFFNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MISTY
Other - Middle Name:ANN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9909 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:240-864-6000
Mailing Address - Fax:240-864-6049
Practice Address - Street 1:9909 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:240-864-6000
Practice Address - Fax:240-864-6049
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist