Provider Demographics
NPI:1790995686
Name:SCRUGGS, SHELLEY ANN (PT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-4328
Mailing Address - Country:US
Mailing Address - Phone:706-638-6073
Mailing Address - Fax:
Practice Address - Street 1:205 ROADRUNNER BLVD
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2161
Practice Address - Country:US
Practice Address - Phone:706-638-8770
Practice Address - Fax:706-638-8770
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist