Provider Demographics
NPI:1073832739
Name:VOGT, EDWARD JOHN (LMT 0006994)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:VOGT
Suffix:
Gender:M
Credentials:LMT 0006994
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10014 JOHNS RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8811
Mailing Address - Country:US
Mailing Address - Phone:830-816-2624
Mailing Address - Fax:830-816-2621
Practice Address - Street 1:10014 JOHNS RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8811
Practice Address - Country:US
Practice Address - Phone:830-816-2624
Practice Address - Fax:830-816-2621
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT0006994225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist