Provider Demographics
NPI:1801308226
Name:PUGH, JOSHUA DWAYNE (LMT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DWAYNE
Last Name:PUGH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:WALTERVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97489-0278
Mailing Address - Country:US
Mailing Address - Phone:541-514-4819
Mailing Address - Fax:
Practice Address - Street 1:384 Q ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2140
Practice Address - Country:US
Practice Address - Phone:541-514-4819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19747225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist