Provider Demographics
NPI:1639584006
Name:OGA, RUEL (PT)
Entity Type:Individual
Prefix:MR
First Name:RUEL
Middle Name:
Last Name:OGA
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 1:491 RIDDLE LN
Mailing Address - Street 2:APT 22
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-5485
Mailing Address - Country:US
Mailing Address - Phone:318-381-4722
Mailing Address - Fax:
Practice Address - Street 1:491 RIDDLE LN
Practice Address - Street 2:APT 22
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-5485
Practice Address - Country:US
Practice Address - Phone:318-381-4722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08273F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist