MEDICARE: MS. KRISTEN FOGLE DPT, PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	014353	OH
2	225100000X	Physical Therapist	PT-014353	OH

General Provider Information

NPI Number	:	1568877751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTEN FOGLE DPT, PT

Provider Business Mailing Address
First Line	:	1110 HEPPLEWHITE ST
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-1118
Country	:	US
Telephone Number	:	614-657-5930
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 OLD HENDERSON RD STE S-204
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3626
Country	:	US
Telephone Number	:	614-657-5930
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	09/07/2020

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