MEDICARE: MRS. LISA T. HOGLUND PT, OCS

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	2251X0800X	Orthopedic Physical Therapist	PT002542E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0824186000	OTHER	PA	BC/BS HMO PROVIDER NUMBER
2	7316644	OTHER	PA	AETNA
3	800468	OTHER	PA	BC/BS PPO PROVIDER NUMBER

General Provider Information

NPI Number	:	1710985957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA T. HOGLUND PT, OCS

Provider Business Mailing Address
First Line	:	195 RICE DR
Second Line	:
City	:	MORRISVILLE
State	:	PA
Zip	:	19067-5961
Country	:	US
Telephone Number	:	215-428-0244
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 BUSTLETON AVE
Second Line	:	SUITE 204
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3328
Country	:	US
Telephone Number	:	215-335-7400
Fax Number	:	215-335-7404

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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