Provider Demographics
NPI:1205040441
Name:COGLE, MAURICE GEORGE (PT)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:GEORGE
Last Name:COGLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 THORNTON DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-8036
Mailing Address - Country:US
Mailing Address - Phone:561-628-3154
Mailing Address - Fax:561-776-9580
Practice Address - Street 1:203 THORNTON DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-8036
Practice Address - Country:US
Practice Address - Phone:561-628-3154
Practice Address - Fax:561-776-9580
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT92439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist