Provider Demographics
NPI:1538240023
Name:FOGLER, SETH HOWARD (MS, ATC, LAT 390)
Entity type:Individual
Prefix:MR
First Name:SETH
Middle Name:HOWARD
Last Name:FOGLER
Suffix:
Gender:M
Credentials:MS, ATC, LAT 390
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19675 NW 62ND CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8130
Mailing Address - Country:US
Mailing Address - Phone:305-970-3843
Mailing Address - Fax:
Practice Address - Street 1:14100 NW 89TH AVE
Practice Address - Street 2:GOLEMAN SR. HIGH
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-1384
Practice Address - Country:US
Practice Address - Phone:305-362-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 3902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer