Provider Demographics
NPI:1841366655
Name:VOGEL, ANDREW L (PT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:L
Last Name:VOGEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 LAHMEYER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5676
Mailing Address - Country:US
Mailing Address - Phone:260-432-4700
Mailing Address - Fax:260-459-9262
Practice Address - Street 1:2170 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-9292
Practice Address - Country:US
Practice Address - Phone:260-824-0522
Practice Address - Fax:260-824-1896
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002015A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200362900AMedicaid
IN000000197323OtherANTHEM BCBS
IN35179001202OtherCARESOURCE
IN1424OtherPHP
IN4423623OtherAETNA
IN156546Medicare ID - Type Unspecified