Basic Information
| Provider Information | |||||||||
| NPI: | 1487062766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOGLE | ||||||||
| FirstName: | LUKE | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742785 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900742785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412424812 | ||||||||
| FaxNumber: | 5416843074 | ||||||||
| Practice Location | |||||||||
| Address1: | 1435 G ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974774113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412424812 | ||||||||
| FaxNumber: | 5412424813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2014 | ||||||||
| LastUpdateDate: | 07/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 60715 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.