Provider Demographics
NPI:1306833751
Name:OGREN, CHARLES Y (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:Y
Last Name:OGREN
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 1:6216 PINO REAL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2512
Mailing Address - Country:US
Mailing Address - Phone:915-613-2347
Mailing Address - Fax:915-613-2524
Practice Address - Street 1:6216 PINO REAL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2512
Practice Address - Country:US
Practice Address - Phone:915-613-2347
Practice Address - Fax:915-613-2524
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8A3279Medicare ID - Type Unspecified