MEDICARE: MR. TIMOTHY J OGLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251S0007X	Sports Physical Therapist	AT-865	OH
2	2251X0800X	Orthopedic Physical Therapist	PT-9535	OH

General Provider Information

NPI Number	:	1336330893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY J OGLE

Provider Business Mailing Address
First Line	:	1114 E MAIN ST
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-3449
Country	:	US
Telephone Number	:	937-232-5359
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 CINCINNATI ST
Second Line	:	SUITE 100
City	:	DAYTON
State	:	OH
Zip	:	45417-4670
Country	:	US
Telephone Number	:	937-449-0800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	12/23/2010

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