Provider Demographics
NPI:1396477436
Name:HOGAN, PAUL (LMT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HOGAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 SW RUTLAND TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-5854
Mailing Address - Country:US
Mailing Address - Phone:971-601-6154
Mailing Address - Fax:
Practice Address - Street 1:2722 SW RUTLAND TER
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-5854
Practice Address - Country:US
Practice Address - Phone:971-601-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR26393OtherOREGON LICENSE NUMBER