Provider Demographics
NPI:1043476799
Name:ROSS-PUGH, DANITA RENEE (LMT)
Entity type:Individual
Prefix:
First Name:DANITA
Middle Name:RENEE
Last Name:ROSS-PUGH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6022 GREEN TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-5421
Mailing Address - Country:US
Mailing Address - Phone:713-542-4959
Mailing Address - Fax:
Practice Address - Street 1:6022 GREEN TERRACE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-5421
Practice Address - Country:US
Practice Address - Phone:713-542-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT041165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist