Provider Demographics
NPI:1922212679
Name:PUGH, KELLI FRYE (MS, ATC, CMT)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:FRYE
Last Name:PUGH
Suffix:
Gender:F
Credentials:MS, ATC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 SUTTON CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-3757
Mailing Address - Country:US
Mailing Address - Phone:434-249-3952
Mailing Address - Fax:
Practice Address - Street 1:290 MASSIE RD
Practice Address - Street 2:MCCUE CENTER, ROOM 112
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22904-4834
Practice Address - Country:US
Practice Address - Phone:434-982-5450
Practice Address - Fax:424-982-5470
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260004882255A2300X
VA0019003474225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist