Provider Demographics
NPI:1215922158
Name:PUGIA, MARIA LYNN (MPT)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LYNN
Last Name:PUGIA
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 1:128 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5638
Mailing Address - Country:US
Mailing Address - Phone:310-363-0908
Mailing Address - Fax:310-363-0456
Practice Address - Street 1:2420 VELA WAY
Practice Address - Street 2:SUITE 1467
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4659
Practice Address - Country:US
Practice Address - Phone:310-363-0908
Practice Address - Fax:310-363-0456
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29141225100000X
TX1137164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist