Provider Demographics
NPI:1669493797
Name:HOGAN THERAPY ASSOCIATES INC.
Entity Type:Organization
Organization Name:HOGAN THERAPY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENTLY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:318-322-9980
Mailing Address - Street 1:1123 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4307
Mailing Address - Country:US
Mailing Address - Phone:318-322-9980
Mailing Address - Fax:318-322-9946
Practice Address - Street 1:1123 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4307
Practice Address - Country:US
Practice Address - Phone:318-322-9980
Practice Address - Fax:318-322-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CR37Medicare ID - Type UnspecifiedPHYSICAL THERAPY GROUP