Provider Demographics
NPI:1669488714
Name:RAGUSE, ANNMARIE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ANNMARIE
Middle Name:
Last Name:RAGUSE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:ANNMARIE
Other - Middle Name:
Other - Last Name:BUSSONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 N PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3189
Practice Address - Country:US
Practice Address - Phone:248-693-6835
Practice Address - Fax:248-693-7743
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist