Individual
RYAN BUGNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1819 E BIG BEAVER RD, STE 200, TROY, MI 48083-2015
(248) 619-1733
(248) 619-1744
Mailing address
1819 E BIG BEAVER RD, STE 200, TROY, MI 48083-2015
(248) 619-1733
(248) 619-1744
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502004841
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
236742
MEDICARE PROVIDER ID
MI
01
—
30696
BCBS FACILITY ID
MI
Enumeration date
03/01/2016
Last updated
03/01/2016
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