Healthcare Provider Details

I. General information

NPI: 1659574895
Provider Name (Legal Business Name): HOLLY RENEE HOGANSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N HOBART ST SPACE 2JS
PAMPA TX
79065-4641
US

IV. Provider business mailing address

2617 CHEROKEE DR
PAMPA TX
79065-3105
US

V. Phone/Fax

Practice location:
  • Phone: 806-665-4820
  • Fax: 806-665-4123
Mailing address:
  • Phone: 806-665-4820
  • Fax: 806-665-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2042018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: