Provider Demographics
NPI:1659355493
Name:OGLE, JOE A (PT)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:A
Last Name:OGLE
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 1:511 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-6962
Mailing Address - Country:US
Mailing Address - Phone:405-707-0900
Mailing Address - Fax:405-707-3363
Practice Address - Street 1:511 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-6962
Practice Address - Country:US
Practice Address - Phone:405-707-0900
Practice Address - Fax:405-707-3363
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18382251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200036210AMedicaid
Q24069Medicare UPIN
243716305Medicare PIN