Healthcare Provider Details

I. General information

NPI: 1306833751
Provider Name (Legal Business Name): CHARLES Y OGREN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 PINO REAL DR
EL PASO TX
79912-2512
US

IV. Provider business mailing address

6216 PINO REAL DR
EL PASO TX
79912-2512
US

V. Phone/Fax

Practice location:
  • Phone: 915-613-2347
  • Fax: 915-613-2524
Mailing address:
  • Phone: 915-613-2347
  • Fax: 915-613-2524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1041358
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: