Provider Demographics
NPI:1255757365
Name:HOGGE, BRENDA (DPT)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:HOGGE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:SOMERVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:888-201-1040
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:736 SOUTH 2000 WEST
Practice Address - Street 2:SUITE 1
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-6702
Practice Address - Country:US
Practice Address - Phone:801-985-2700
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3228992401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U000086220Medicare PIN
P01322550Medicare PIN