Provider Demographics
NPI:1770605750
Name:CHARLES OGREN
Entity type:Organization
Organization Name:CHARLES OGREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:OGREN
Authorized Official - Suffix:
Authorized Official - Credentials:PT MS DPT
Authorized Official - Phone:915-820-0459
Mailing Address - Street 1:6216 PINO REAL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2512
Mailing Address - Country:US
Mailing Address - Phone:915-820-0459
Mailing Address - Fax:915-613-2524
Practice Address - Street 1:6216 PINO REAL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2512
Practice Address - Country:US
Practice Address - Phone:915-820-0459
Practice Address - Fax:915-613-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty