Provider Demographics
NPI:1780091108
Name:SCRUGGS, JENNIFER (MED, ATS, LAT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:MED, ATS, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ACU BOX 27916
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79699
Mailing Address - Country:US
Mailing Address - Phone:785-456-5967
Mailing Address - Fax:
Practice Address - Street 1:ACU BOX 27916
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79699
Practice Address - Country:US
Practice Address - Phone:785-456-5967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT49152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer