Provider Demographics
NPI:1689150534
Name:LUGUS, KRISTIINA LEIDA (AT)
Entity Type:Individual
Prefix:
First Name:KRISTIINA
Middle Name:LEIDA
Last Name:LUGUS
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:TIINA
Other - Middle Name:LEIDA
Other - Last Name:LUGUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AT
Mailing Address - Street 1:363 RICHLAND AVE APT 369
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3285
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:363 RICHLAND AVE APT 369
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-3285
Practice Address - Country:US
Practice Address - Phone:678-925-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0056822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer