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General NPI Number Information
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NPI Number | 1528614781
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Entity Type | Individual
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Provider Name | ALEX FOGT DPT
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Gender | Male
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 380 N ESTRELLA PKWY STE A1
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City | GOODYEAR
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State | AZ
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Zip | 85338-2885
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Country | US
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Telephone | 623-322-0654
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Fax | 623-322-0664
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone | 866-370-8206
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Fax | 517-435-3670
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | LPT-32055
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT210002132
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05014613A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT018257
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP011725T
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License Number State | MD
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