Provider Demographics
NPI:1073808960
Name:WOGTECH, EMILY MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:WOGTECH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MARIE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1030 E COUNTY LINE RD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2932
Mailing Address - Country:US
Mailing Address - Phone:317-887-1121
Mailing Address - Fax:317-887-1127
Practice Address - Street 1:1030 E COUNTY LINE RD
Practice Address - Street 2:SUITE A2
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2932
Practice Address - Country:US
Practice Address - Phone:317-887-1121
Practice Address - Fax:317-887-1127
Is Sole Proprietor?:No
Enumeration Date:2011-06-18
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26482225100000X
IN05011116A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist