Provider Demographics
NPI:1083909006
Name:PRUGH, JENNIFER WEGEHAUPT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WEGEHAUPT
Last Name:PRUGH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2783 SW 87TH DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-9375
Mailing Address - Country:US
Mailing Address - Phone:352-505-6665
Mailing Address - Fax:352-226-8744
Practice Address - Street 1:2783 SW 87TH DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9375
Practice Address - Country:US
Practice Address - Phone:352-505-6665
Practice Address - Fax:352-226-8744
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist