Individual
BRIAN KELLY POGUE
Active
Individual
BRIAN KELLY POGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-25067
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K-3234
BEACHSIDE P.T. GROUP NUMBER
FL
01
—
PT-25067
STATE OF FL. PT LICENSE
FL
Enumeration date
10/23/2009
Last updated
05/26/2011
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