Provider Demographics
NPI:1447599980
Name:VOGT, STACY LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:VOGT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W BENJAMIN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2769
Mailing Address - Country:US
Mailing Address - Phone:402-371-9707
Mailing Address - Fax:
Practice Address - Street 1:1220 W BENJAMIN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2769
Practice Address - Country:US
Practice Address - Phone:402-371-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE657225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant