Provider Demographics
NPI:1790092286
Name:PUGH, PRESTON FELTY (SLP)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:FELTY
Last Name:PUGH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13122 WALTONS TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-3056
Mailing Address - Country:US
Mailing Address - Phone:804-317-3509
Mailing Address - Fax:
Practice Address - Street 1:13122 WALTONS TAVERN RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192
Practice Address - Country:US
Practice Address - Phone:804-317-3509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist