Provider Demographics
NPI:1255732301
Name:OGLE, GREGORY (DPT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:OGLE
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 1:362 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4950
Mailing Address - Country:US
Mailing Address - Phone:508-584-7711
Mailing Address - Fax:508-584-7744
Practice Address - Street 1:535 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-5261
Practice Address - Country:US
Practice Address - Phone:781-961-3370
Practice Address - Fax:781-767-7531
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist