Provider Demographics
NPI:1760805709
Name:VOGAN, NATHAN DANIEL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:DANIEL
Last Name:VOGAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 MEBANE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7951
Mailing Address - Country:US
Mailing Address - Phone:919-563-1825
Mailing Address - Fax:919-563-1833
Practice Address - Street 1:3302 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7445
Practice Address - Country:US
Practice Address - Phone:919-872-3747
Practice Address - Fax:919-872-3414
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC346512Medicare Oscar/Certification