Provider Demographics
NPI:1215551726
Name:VOGT, KEITH JOSEPH (RPT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:JOSEPH
Last Name:VOGT
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1491
Mailing Address - Country:US
Mailing Address - Phone:415-602-2898
Mailing Address - Fax:650-355-8206
Practice Address - Street 1:188 BONNIE LN
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1491
Practice Address - Country:US
Practice Address - Phone:415-602-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist