Individual
EMILY MOGK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
555 E BROADWAY AVE STE 100, JACKSON, WY 83001-8640
(307) 739-7487
Mailing address
222 1/2 EAST KELLY AVE, JACKSON, WY 83001
(406) 570-1475
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1481
WY
225100000X
Physical Therapist
81611-1184
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1481
PHYSICAL THERAPY LICENSE
WY
Enumeration date
02/26/2013
Last updated
02/20/2018
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