Provider Demographics
NPI:1457456600
Name:KOLOGLU, JO A (PT)
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:A
Last Name:KOLOGLU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JO
Other - Middle Name:
Other - Last Name:HANEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5025 SMITHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934
Mailing Address - Country:US
Mailing Address - Phone:321-947-6417
Mailing Address - Fax:321-259-7907
Practice Address - Street 1:5025 SMITHFIELD RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934
Practice Address - Country:US
Practice Address - Phone:321-947-6417
Practice Address - Fax:321-259-7907
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17439PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY003ROtherBCBS OF FLORIDA