Provider Demographics
NPI:1669812012
Name:LEGGETT, JESSICA RUGE (DPT)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RUGE
Last Name:LEGGETT
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:PO BOX 1181
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-1181
Mailing Address - Country:US
Mailing Address - Phone:703-615-9351
Mailing Address - Fax:
Practice Address - Street 1:2756 US HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-8903
Practice Address - Country:US
Practice Address - Phone:703-615-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052055822251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics