MEDICARE: NATHAN JAMES HOGLUND

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	PAR-0000342403	WI

General Provider Information

NPI Number	:	1902634215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN JAMES HOGLUND

Provider Business Mailing Address
First Line	:	1187 EVERGREEN LN APT 3
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-8850
Country	:	US
Telephone Number	:	715-828-0604
Fax Number	:

Provider Business Practice Location Address
First Line	:	1446 116TH STREET CHIPPEWA FALLS
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729
Country	:	US
Telephone Number	:	715-514-1572
Fax Number	:	715-514-1576

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

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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