Provider Demographics
NPI:1295854693
Name:FUGATT, JENNIFER MORTON (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MORTON
Last Name:FUGATT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GERORGE TOWN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-454-6262
Mailing Address - Fax:239-454-0350
Practice Address - Street 1:15620 MCGREGOR BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2528
Practice Address - Country:US
Practice Address - Phone:239-454-6262
Practice Address - Fax:239-454-0350
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist