Provider Demographics
NPI:1093328775
Name:PUGH, MEGHAN ROSE (DAT, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:ROSE
Last Name:PUGH
Suffix:
Gender:F
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 S WASHINGTON ST APT 119
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4496
Mailing Address - Country:US
Mailing Address - Phone:808-294-1026
Mailing Address - Fax:
Practice Address - Street 1:24164 BELLEAU AVE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5106
Practice Address - Country:US
Practice Address - Phone:808-294-1026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL63192255A2300X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty