Provider Demographics
NPI:1043550932
Name:ERICA WOGALTER PT GROUP INC.
Entity Type:Organization
Organization Name:ERICA WOGALTER PT GROUP INC.
Other - Org Name:WOGALTER PT GROUP INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WOGALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:561-289-5186
Mailing Address - Street 1:19548 ESTUARY DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6201
Mailing Address - Country:US
Mailing Address - Phone:561-212-4638
Mailing Address - Fax:561-482-3599
Practice Address - Street 1:19548 ESTUARY DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6201
Practice Address - Country:US
Practice Address - Phone:561-212-4638
Practice Address - Fax:561-482-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty