Healthcare Provider Details

I. General information

NPI: 1891283420
Provider Name (Legal Business Name): ADAM ROBERT PUGH DPT, L/ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N MAIN ST STE 41
MARION VA
24354-4121
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 276-781-0929
  • Fax: 276-781-0936
Mailing address:
  • Phone: 423-238-9930
  • Fax: 423-254-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305212218
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0123002687
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: