Provider Demographics
NPI:1720971765
Name:FUGATE, ANALIESE RAE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:ANALIESE
Middle Name:RAE
Last Name:FUGATE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 BROOKVIEW CT APT 6
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-2130
Mailing Address - Country:US
Mailing Address - Phone:937-856-7221
Mailing Address - Fax:
Practice Address - Street 1:97 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-2600
Practice Address - Country:US
Practice Address - Phone:937-856-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0071762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer