Provider Demographics
NPI:1134103013
Name:GOGL, LINDA SUSAN (DPT, OCS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:GOGL
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:SUSAN
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:12510 E ILIFF AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-6377
Mailing Address - Country:US
Mailing Address - Phone:303-862-8853
Mailing Address - Fax:720-379-5827
Practice Address - Street 1:12510 E ILIFF AVE STE 210
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6377
Practice Address - Country:US
Practice Address - Phone:303-862-8853
Practice Address - Fax:720-379-5827
Is Sole Proprietor?:No
Enumeration Date:2005-12-03
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT200961OtherMEDICARE PTAN
CA0PT200960OtherBLUE SHIELD OF CALIFORNIA
CO1134103013Medicaid