Provider Demographics
NPI:1891738258
Name:HOGAN, JUDY L (LPT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:L
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 N TYLER RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3265
Mailing Address - Country:US
Mailing Address - Phone:316-773-0909
Mailing Address - Fax:316-773-0606
Practice Address - Street 1:940 N TYLER RD
Practice Address - Street 2:STE. 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3265
Practice Address - Country:US
Practice Address - Phone:316-773-0909
Practice Address - Fax:316-773-0606
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3132OtherPREFERRED PLUS OF KANSAS
KS141041OtherBLUE CROSS BLUE SHIELD
KS3132OtherPREFERRED PLUS OF KANSAS