Provider Demographics
NPI:1932766540
Name:VOGELE, JUSTINE (PTA)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:VOGELE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23130 282ND RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:KS
Mailing Address - Zip Code:67038-9033
Mailing Address - Country:US
Mailing Address - Phone:620-218-9718
Mailing Address - Fax:
Practice Address - Street 1:2211 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1841
Practice Address - Country:US
Practice Address - Phone:580-765-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03886225200000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer