Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT.3314PT | SC |
NPI | 1194234591 |
---|---|
Provider Name | Craig Raymond Ruggiero |
First Address | Florence, SC 29505 |
Second Address | Florence, SC 29506-2559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2017 |
Last Update Date | 28/09/2017 |