Provider Demographics
NPI:1689825325
Name:FOGEL, LINDA (LPTA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FOGEL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 MESA RD
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2061
Mailing Address - Country:US
Mailing Address - Phone:850-623-4054
Mailing Address - Fax:850-623-4987
Practice Address - Street 1:5165 CANAL ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-2256
Practice Address - Country:US
Practice Address - Phone:850-623-4054
Practice Address - Fax:850-623-4987
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20294225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant