Provider Demographics
NPI:1720434079
Name:JOGODKA, CARLEEN (PT)
Entity Type:Individual
Prefix:DR
First Name:CARLEEN
Middle Name:
Last Name:JOGODKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 E CAMINO DE LOS OLIVOS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3716
Mailing Address - Country:US
Mailing Address - Phone:612-747-3190
Mailing Address - Fax:
Practice Address - Street 1:850 N KOLB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1333
Practice Address - Country:US
Practice Address - Phone:520-885-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6446225100000X
MN8878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist