Provider Demographics
NPI:1932359767
Name:SCRUGGS, CORA HEATHER (PT)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:HEATHER
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 1:1301 E BIDWELL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3452
Mailing Address - Country:US
Mailing Address - Phone:916-983-5915
Mailing Address - Fax:916-983-5925
Practice Address - Street 1:7805 LAGUNA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7952
Practice Address - Country:US
Practice Address - Phone:916-691-5400
Practice Address - Fax:916-691-5427
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist