Provider Demographics
NPI:1124414685
Name:SOGLA, PAT (ATC)
Entity Type:Individual
Prefix:
First Name:PAT
Middle Name:
Last Name:SOGLA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WATER ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5680
Mailing Address - Country:US
Mailing Address - Phone:715-497-6219
Mailing Address - Fax:
Practice Address - Street 1:401 WATER ST
Practice Address - Street 2:APT. 1
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5680
Practice Address - Country:US
Practice Address - Phone:715-497-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-11
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer