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NPI Code Detail

MEDICARE: MRS. LAUREL BOGLE PTA

MEDICARE: MRS. LAUREL BOGLE PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2000XPhysical Therapy Clinic/Center3206TN

General Provider Information

NPI Number : 1386195782
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAUREL BOGLE PTA
Provider Business Mailing Address
First Line : 1098 BLUE SPRINGS RD
Second Line :
City : SMITHVILLE
State : TN
Zip : 37166-6075
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 825 FISHER AVE
Second Line :
City : SMITHVILLE
State : TN
Zip : 37166-2140
Country : US
Telephone Number : 615-597-4182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2016
Last Update Date : 10/20/2016

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Directions to “ MRS. LAUREL BOGLE PTA” Practice Location

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