Individual
MR. PHILLIP DWAYNE FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.A.
Contact information
Practice address
101 GRACE DR, EASLEY, SC 29640-9088
(864) 679-3100
Mailing address
2467 BEAVER CREEK LN, AIKEN, SC 29803-4101
(803) 649-0446
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1067
SC
Other
Enumeration date
03/23/2007
Last updated
07/08/2007
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