MEDICARE: DANIEL J MOGENSEN D.P.T

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	225100000X	Physical Therapist	P13743	NC

General Provider Information

NPI Number	:	1740619725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL J MOGENSEN D.P.T

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8045 PROVIDENCE RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8916
Country	:	US
Telephone Number	:	704-316-1222
Fax Number	:

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

Provider Enumeration Date	:	11/11/2013
Last Update Date	:	01/20/2023

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