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NPI Code Detail

MEDICARE: BRENTLY SHANE HOGAN PT, DPT

MEDICARE: BRENTLY SHANE HOGAN PT, DPT
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
1225100000XPhysical Therapist06610LA

General Provider Information

NPI Number : 1740201870
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENTLY SHANE HOGAN PT, DPT
Provider Business Mailing Address
First Line : 1123 FORSYTHE AVE
Second Line :
City : MONROE
State : LA
Zip : 71201-4307
Country : US
Telephone Number : 318-322-9980
Fax Number : 318-322-9946
Provider Business Practice Location Address
First Line : 1123 FORSYTHE AVE
Second Line :
City : MONROE
State : LA
Zip : 71201-4307
Country : US
Telephone Number : 318-322-9980
Fax Number : 318-322-9946
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2006
Last Update Date : 07/08/2007

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Directions to “ BRENTLY SHANE HOGAN PT, DPT” Practice Location

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