Marisa Christine Pugh, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

10631644-2402 Issued in UT

Practice address

2500 S State St
South Salt Lake, UT 84115-3164

Phone

(385) 646-5000

NPI assigned

May 9, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653350400000",
    "number": "1356087811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4420 S NIELSEN WAY",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841195727",
            "telephone_number": "801-815-5179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 S STATE ST",
            "city": "SOUTH SALT LAKE",
            "state": "UT",
            "postal_code": "841153164",
            "telephone_number": "385-646-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUGH",
        "first_name": "MARISA",
        "middle_name": "CHRISTINE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-09",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "UT",
            "license": "10631644-2402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sophia Rey Pontello
• Devin Pope
• Elizabeth Popescue
• Julianna Marie Potter, CSW
• Pro DME LLC
• Heidi Qin
• Caroline Chau Quach
• Melissa Radcliffe, APNP
• Kysa C Radley Osborne, LCSW
• Janine Robyn Radley, SLP

• Physical Therapy Assistant in South Salt Lake, UT
• Providers in South Salt Lake, UT by specialty
• Physical Therapy Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.