Provider Demographics
NPI:1346571551
Name:PUGH, JOHN R (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:PUGH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-1583
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-7752
Practice Address - Street 1:504 ALBEMARLE SQ
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-7405
Practice Address - Country:US
Practice Address - Phone:434-817-7848
Practice Address - Fax:434-951-2194
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305206343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA022958P25Medicare PIN