Provider Demographics
NPI:1962496216
Name:OGLE, JANNA DIANE (PT)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:DIANE
Last Name:OGLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4157 S HARVARD AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2631
Mailing Address - Country:US
Mailing Address - Phone:918-743-2988
Mailing Address - Fax:918-743-2988
Practice Address - Street 1:4157 S HARVARD AVE
Practice Address - Street 2:STE 111
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2631
Practice Address - Country:US
Practice Address - Phone:918-743-2988
Practice Address - Fax:918-743-3248
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKA002OtherTRICARE
OK9805OtherBLUE LINCS HMO