Provider Demographics
NPI:1417131707
Name:VOGEL, ANNA (PTA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:VOGEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:GUBBINS
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17554 GILBERT DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-1114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1065 E 9TH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3567
Practice Address - Country:US
Practice Address - Phone:815-588-1366
Practice Address - Fax:815-588-2010
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant