Individual
TIMOTHY JOHN FUGATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
51 PETERS RD STE 200, LITITZ, PA 17543-7685
(717) 627-7675
Mailing address
113 COUNTRY SIDE LN, LEOLA, PA 17540-1647
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RTO000456
PA
Other
Enumeration date
08/21/2020
Last updated
08/21/2020
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