Provider Demographics
NPI:1316559818
Name:HOGAN, KATIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 HYDRANGEA CIR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7264
Mailing Address - Country:US
Mailing Address - Phone:931-797-3755
Mailing Address - Fax:
Practice Address - Street 1:1327 HYDRANGEA CIR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7264
Practice Address - Country:US
Practice Address - Phone:931-797-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13016225100000X
NCP100114E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist