Healthcare Provider Details

I. General information

NPI: 1861426389
Provider Name (Legal Business Name): JOSHUA P HOGAN MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W BROAD ST SUITE 2
HAZLETON PA
18201-6407
US

IV. Provider business mailing address

2 TOMMYS CT
DRUMS PA
18222-1007
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-4559
  • Fax: 570-459-4558
Mailing address:
  • Phone: 570-708-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012834L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: