Provider Demographics
NPI:1063626281
Name:JOHN KOEGEL, PT INC.
Entity type:Organization
Organization Name:JOHN KOEGEL, PT INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-659-3018
Mailing Address - Street 1:8920 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 335
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-659-3018
Mailing Address - Fax:310-657-0816
Practice Address - Street 1:8920 WILSHIRE BLVD.
Practice Address - Street 2:SUITE 335
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-659-3018
Practice Address - Fax:310-657-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9352261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT9352AMedicare ID - Type Unspecified