Provider Demographics
NPI:1659779957
Name:HOGUE, GRETCHEN (LMT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:HOGUE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 SE TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4037
Mailing Address - Country:US
Mailing Address - Phone:971-230-8475
Mailing Address - Fax:
Practice Address - Street 1:3339 SE DIVISION ST
Practice Address - Street 2:SUITE F - AKASA THAI HEALING ARTS
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1492
Practice Address - Country:US
Practice Address - Phone:971-230-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12283172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist