Provider Demographics
NPI:1811996812
Name:VOGELBACH, WILLIAM DANIEL (PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DANIEL
Last Name:VOGELBACH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:W
Other - Middle Name:DANIEL
Other - Last Name:VOGELBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2328 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1459
Mailing Address - Country:US
Mailing Address - Phone:239-573-1518
Mailing Address - Fax:239-573-7356
Practice Address - Street 1:2328 HANCOCK BRIDGE PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1459
Practice Address - Country:US
Practice Address - Phone:239-574-7557
Practice Address - Fax:239-574-1315
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686520OtherMEDICARE GROUP