Provider Demographics
NPI:1861776205
Name:FOGEL, ERIC ROGER (PT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ROGER
Last Name:FOGEL
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 1:5432 BEE RIDGE RD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1514
Mailing Address - Country:US
Mailing Address - Phone:941-379-7913
Mailing Address - Fax:941-379-4614
Practice Address - Street 1:5432 BEE RIDGE RD
Practice Address - Street 2:SUITE #110
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1514
Practice Address - Country:US
Practice Address - Phone:941-379-7913
Practice Address - Fax:941-379-4614
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist