Provider Demographics
NPI:1629664479
Name:PUGH, FELICIA (LMT, CO)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:
Last Name:PUGH
Suffix:
Gender:F
Credentials:LMT, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 BUCHANAN STREET
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001
Mailing Address - Country:US
Mailing Address - Phone:724-581-1957
Mailing Address - Fax:
Practice Address - Street 1:1747 BUCHANAN ST APT SUITE
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-1915
Practice Address - Country:US
Practice Address - Phone:724-581-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG007189225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist