Basic Information
| Provider Information | |||||||||
| NPI: | 1831139120 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOGUT | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 W WHITE HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | GALLOWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082059447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094321942 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4 E JIMMIE LEEDS RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | GALLOWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082054465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097484288 | ||||||||
| FaxNumber: | 6097484282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00783600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.