Healthcare Provider Details

I. General information

NPI: 1700166618
Provider Name (Legal Business Name): MICHELLE ALISEMARIE BOGERT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE ALISEMARIE KEYES DPT

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 E GLENDALE AVE SUITE 105
PHOENIX AZ
85020-4900
US

IV. Provider business mailing address

3940 E ROSEMONTE DR
PHOENIX AZ
85050-3285
US

V. Phone/Fax

Practice location:
  • Phone: 602-241-3145
  • Fax:
Mailing address:
  • Phone: 636-634-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: