Provider Demographics
NPI:1194776070
Name:HOGAN, MICHAEL PATRICK (PT, MPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:HOGAN
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 TENNEY MOUNTAIN HWY
Mailing Address - Street 2:UNIT 3 TENNEY MTN PLAZA
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3155
Mailing Address - Country:US
Mailing Address - Phone:603-536-7777
Mailing Address - Fax:603-536-7787
Practice Address - Street 1:612 TENNEY MOUNTAIN HWY
Practice Address - Street 2:UNIT 3 TENNEY MTN PLAZA
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3155
Practice Address - Country:US
Practice Address - Phone:603-536-7777
Practice Address - Fax:603-536-7787
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH08Y008932NH01OtherANTHEM BCBS
NH30394799Medicaid
NH30394799Medicaid