Basic Information
| Provider Information | |||||||||
| NPI: | 1316609092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOGGE | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | MACKENZIE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 CHINQUAPIN ORCH | ||||||||
| Address2: | |||||||||
| City: | YORKTOWN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236932322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578145023 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13212 HULL STREET RD | ||||||||
| Address2: | |||||||||
| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231122620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044199840 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2021 | ||||||||
| LastUpdateDate: | 10/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305214427 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.