Provider Demographics
NPI:1972913325
Name:FUGATE, JOSEPH
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:FUGATE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46982-8824
Mailing Address - Country:US
Mailing Address - Phone:206-802-1016
Mailing Address - Fax:
Practice Address - Street 1:208 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:IN
Practice Address - Zip Code:46982-8824
Practice Address - Country:US
Practice Address - Phone:206-802-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004626A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant