Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | AT-865 | OH |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT-9535 | OH |
NPI | 1336330893 |
---|---|
Provider Name | Mr. Timothy J Ogle |
First Address | Troy, OH 45373-3449 |
Second Address | Dayton, OH 45417-4670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 23/12/2010 |