Provider Demographics
NPI:1528391919
Name:RUGGLES, JODY ANGELA (LMP)
Entity Type:Individual
Prefix:MISS
First Name:JODY
Middle Name:ANGELA
Last Name:RUGGLES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:JODY
Other - Middle Name:ANGELA
Other - Last Name:ASHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:11404 E ANTLER RD
Mailing Address - Street 2:
Mailing Address - City:CHATTAROY
Mailing Address - State:WA
Mailing Address - Zip Code:99003-9721
Mailing Address - Country:US
Mailing Address - Phone:509-714-4010
Mailing Address - Fax:
Practice Address - Street 1:10709 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1631
Practice Address - Country:US
Practice Address - Phone:509-466-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60110066225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 60110066OtherLICENSE