MEDICARE: JENDAYI HOGAN

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	25715	MD

General Provider Information

NPI Number	:	1851766778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENDAYI HOGAN

Provider Business Mailing Address
First Line	:	411 E TANTALLON DR
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-6124
Country	:	US
Telephone Number	:	202-735-7664
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 E TANTALLON DR
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-6124
Country	:	US
Telephone Number	:	202-735-7664
Fax Number	:

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

Provider Enumeration Date	:	12/03/2015
Last Update Date	:	12/03/2015

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Directions to “ JENDAYI HOGAN ” Practice Location

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