Provider Demographics
NPI:1962179002
Name:FUGAL, GREGORY EARL (DPT)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EARL
Last Name:FUGAL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 EAGLE CREST DR
Mailing Address - Street 2:PHYSICAL THERAPY DEPARTMENT
Mailing Address - City:RANGELY
Mailing Address - State:CO
Mailing Address - Zip Code:81648-2104
Mailing Address - Country:US
Mailing Address - Phone:970-675-4205
Mailing Address - Fax:970-675-4270
Practice Address - Street 1:225 EAGLE CREST DR
Practice Address - Street 2:
Practice Address - City:RANGELY
Practice Address - State:CO
Practice Address - Zip Code:81648-2104
Practice Address - Country:US
Practice Address - Phone:970-675-4205
Practice Address - Fax:970-675-4270
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist