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Individual
JENNIFER ELISE FOGLE
Active
Individual
JENNIFER ELISE FOGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1117612
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209829501
—
TX
01
—
835T98
BLUE CROSS
TX
Enumeration date
03/07/2007
Last updated
01/05/2011
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