Provider Demographics
NPI:1780494922
Name:RUGGLES, TREVOR RAY
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:RAY
Last Name:RUGGLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 SHELA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5782
Mailing Address - Country:US
Mailing Address - Phone:740-357-5672
Mailing Address - Fax:
Practice Address - Street 1:2017 SHELA BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-5782
Practice Address - Country:US
Practice Address - Phone:740-357-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide