Provider Demographics
NPI:1396930244
Name:KOEGEL, JOHN R (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:KOEGEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:8920 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 335
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2007
Mailing Address - Country:US
Mailing Address - Phone:310-659-3018
Mailing Address - Fax:310-657-0816
Practice Address - Street 1:8920 WILSHIRE BLVD
Practice Address - Street 2:SUITE 335
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2007
Practice Address - Country:US
Practice Address - Phone:310-659-3018
Practice Address - Fax:310-657-0816
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT9352AMedicare PIN
CAPT9352Medicare PIN