Provider Demographics
NPI:1710985957
Name:HOGLUND, LISA T (PT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:T
Last Name:HOGLUND
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 RICE DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5961
Mailing Address - Country:US
Mailing Address - Phone:215-428-0244
Mailing Address - Fax:
Practice Address - Street 1:7901 BUSTLETON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3328
Practice Address - Country:US
Practice Address - Phone:215-335-7400
Practice Address - Fax:215-335-7404
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002542E2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0824186000OtherBC/BS HMO PROVIDER NUMBER
PA7316644OtherAETNA
PA800468OtherBC/BS PPO PROVIDER NUMBER
PA7316644OtherAETNA