MEDICARE: MRS. STACY LYNN VOGT PTA

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	225200000X	Physical Therapy Assistant	657	NE

General Provider Information

NPI Number	:	1447599980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY LYNN VOGT PTA

Provider Business Mailing Address
First Line	:	1220 W BENJAMIN AVE
Second Line	:	SUITE 4
City	:	NORFOLK
State	:	NE
Zip	:	68701-2769
Country	:	US
Telephone Number	:	402-371-9707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 W BENJAMIN AVE
Second Line	:	SUITE 4
City	:	NORFOLK
State	:	NE
Zip	:	68701-2769
Country	:	US
Telephone Number	:	402-371-9707
Fax Number	:

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

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	02/04/2013

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