Provider Demographics
NPI:1467453605
Name:VOGEL, DENNIS DUANE (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:DUANE
Last Name:VOGEL
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 1:2500 FIFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7941
Mailing Address - Country:US
Mailing Address - Phone:641-621-1401
Mailing Address - Fax:641-628-7308
Practice Address - Street 1:2500 FIFIELD RD
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7941
Practice Address - Country:US
Practice Address - Phone:641-621-1401
Practice Address - Fax:641-628-7308
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0285858Medicaid
IAI8606Medicare ID - Type Unspecified