Provider Demographics
NPI:1376843201
Name:BUGOS, PATRICIA SHAW (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SHAW
Last Name:BUGOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 NW 34TH ST STE 12
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1187
Mailing Address - Country:US
Mailing Address - Phone:352-333-7090
Mailing Address - Fax:352-333-7091
Practice Address - Street 1:5000 NW 34TH ST STE 12
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1187
Practice Address - Country:US
Practice Address - Phone:352-333-7090
Practice Address - Fax:352-333-7091
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA15716225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist