Provider Demographics
NPI:1659574895
Name:HOGANSON, HOLLY RENEE (PTA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:RENEE
Last Name:HOGANSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-3105
Mailing Address - Country:US
Mailing Address - Phone:806-665-4820
Mailing Address - Fax:806-665-4123
Practice Address - Street 1:1201 N HOBART ST
Practice Address - Street 2:SPACE 2JS
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-4641
Practice Address - Country:US
Practice Address - Phone:806-665-4820
Practice Address - Fax:806-665-4123
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2042018225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant