Provider Demographics
NPI:1619138716
Name:FOGEL, CARRIE B (DPT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:B
Last Name:FOGEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-2800
Mailing Address - Country:US
Mailing Address - Phone:570-524-4446
Mailing Address - Fax:570-522-1179
Practice Address - Street 1:900 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-2800
Practice Address - Country:US
Practice Address - Phone:570-524-4446
Practice Address - Fax:570-522-1179
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherPENDING