Provider Demographics
NPI:1750627402
Name:TUGGY, VICKI (MPT)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:TUGGY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15775 LAGUNA CANYON RD
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3189
Mailing Address - Country:US
Mailing Address - Phone:949-333-3833
Mailing Address - Fax:949-390-8770
Practice Address - Street 1:15775 LAGUNA CANYON RD
Practice Address - Street 2:SUITE # 110
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3189
Practice Address - Country:US
Practice Address - Phone:949-333-3833
Practice Address - Fax:949-390-8770
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist