Provider Demographics
NPI:1366705519
Name:KOGER, ALLYN JORDAN I (PT)
Entity type:Individual
Prefix:MR
First Name:ALLYN
Middle Name:JORDAN
Last Name:KOGER
Suffix:I
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 1:1120 ST. PAUL STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2685
Mailing Address - Country:US
Mailing Address - Phone:410-685-7790
Mailing Address - Fax:410-685-7851
Practice Address - Street 1:1120 ST. PAUL STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2685
Practice Address - Country:US
Practice Address - Phone:410-685-7790
Practice Address - Fax:410-685-7851
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist