Provider Demographics
NPI:1679977052
Name:VOGEL, LARA MARIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:MARIE
Last Name:VOGEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:LARA
Other - Middle Name:MAIRE
Other - Last Name:WENTURINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:191 STARDUST DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3064
Mailing Address - Country:US
Mailing Address - Phone:814-322-2380
Mailing Address - Fax:
Practice Address - Street 1:301 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6409
Practice Address - Country:US
Practice Address - Phone:814-944-0845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist