Individual provider Active NPI

Jennifer Elise Fogle, PT, MPT

  • Physical Therapist
  • Dallas, TX
National Provider Identifier
1760513477
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1117612 Issued in TX
Practice address
1935 Medical District Dr
Dallas, TX 75235-7701
Phone
(214) 456-7994
NPI assigned
Mar 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1117612 TX Primary

Addresses

Primary practice location

1935 Medical District Dr
Dallas, TX 75235-7701

Mailing address

4708 Valleycrest Dr
Arlington, TX 76013-5441
Phone (817) 457-3365

Other identifiers 2

IdentifierTypeStateIssuer
835T98OtherTXBLUE CROSS
209829501MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294185600000",
    "number": "1760513477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4708 VALLEYCREST DR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760135441",
            "telephone_number": "817-457-3365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 MEDICAL DISTRICT DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357701",
            "telephone_number": "214-456-7994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGLE",
        "first_name": "JENNIFER",
        "middle_name": "ELISE",
        "credential": "PT, MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2011-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1117612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "835T98",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209829501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.