Provider Demographics
NPI:1285031476
Name:FUGITT, BRIANA (MS, ATC/LAT)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:FUGITT
Suffix:
Gender:F
Credentials:MS, ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 NALL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1366
Mailing Address - Country:US
Mailing Address - Phone:913-945-9820
Mailing Address - Fax:913-574-1392
Practice Address - Street 1:10730 NALL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1366
Practice Address - Country:US
Practice Address - Phone:913-945-9820
Practice Address - Fax:913-574-1392
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-00861305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service