Provider Demographics
NPI:1972108710
Name:HOGLE, EMILY SUZANNE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:SUZANNE
Last Name:HOGLE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:SUZANNE
Other - Last Name:RUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3214 PERIDOT AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-1217
Mailing Address - Country:US
Mailing Address - Phone:319-830-0695
Mailing Address - Fax:
Practice Address - Street 1:217 E BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-3435
Practice Address - Country:US
Practice Address - Phone:800-268-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty