Provider Demographics
NPI:1790794493
Name:HEBERT-RUGGIO, KELLY SUSAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SUSAN
Last Name:HEBERT-RUGGIO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1432
Mailing Address - Country:US
Mailing Address - Phone:603-491-6923
Mailing Address - Fax:
Practice Address - Street 1:1850 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2911
Practice Address - Country:US
Practice Address - Phone:603-491-6923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17616225100000X
NH3135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist