Provider Demographics
NPI:1770891368
Name:WOGALTER, GLENN R (DPT)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:R
Last Name:WOGALTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19548 ESTUARY DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6201
Mailing Address - Country:US
Mailing Address - Phone:561-289-5186
Mailing Address - Fax:561-482-3599
Practice Address - Street 1:19548 ESTUARY DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6201
Practice Address - Country:US
Practice Address - Phone:561-289-5186
Practice Address - Fax:561-482-3599
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist