Basic Information
| Provider Information | |||||||||
| NPI: | 1962179002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FUGAL | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | EARL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 EAGLE CREST DR | ||||||||
| Address2: | PHYSICAL THERAPY DEPARTMENT | ||||||||
| City: | RANGELY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816482104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706754205 | ||||||||
| FaxNumber: | 9706754270 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 EAGLE CREST DR | ||||||||
| Address2: | |||||||||
| City: | RANGELY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816482104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706754205 | ||||||||
| FaxNumber: | 9706754270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2021 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTL.0017481 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.