Provider Demographics
NPI:1134478019
Name:DOHOGNE, LANCE MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:MICHAEL
Last Name:DOHOGNE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 PHYSICIANS PARK STE 101
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3918
Mailing Address - Country:US
Mailing Address - Phone:573-778-9348
Mailing Address - Fax:
Practice Address - Street 1:225 PHYSICIANS PARK STE 101
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3918
Practice Address - Country:US
Practice Address - Phone:573-778-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist