Provider Demographics
NPI:1497896575
Name:FOGEL, NANCY C (PT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:C
Last Name:FOGEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18323 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5246
Mailing Address - Country:US
Mailing Address - Phone:425-806-5721
Mailing Address - Fax:425-806-5701
Practice Address - Street 1:231 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2744
Practice Address - Country:US
Practice Address - Phone:360-563-1020
Practice Address - Fax:360-563-9040
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8340077Medicaid
WAAB15750Medicare ID - Type Unspecified