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General NPI Number Information
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NPI Number | 1114488392
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Entity Type | Individual
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Provider Name | BENJAMIN F FOGEL DPT, CERT. MDT
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Gender | Male
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 3551 ROGER BROOKE DR
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-916-7812
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Fax |
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Provider Business Mailing Address
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Address Line | 503 AVENUE A APT 1245
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1274
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Country | US
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Telephone | 330-224-6818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT31722
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License Number State | FL
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