Healthcare Provider Details

I. General information

NPI: 1508313065
Provider Name (Legal Business Name): LAWRENCE ROBERT BOGNER II PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 CLARK RD STE F
BATH MI
48808-8789
US

IV. Provider business mailing address

13922 MEAD CREEK RD
BATH MI
48808-8704
US

V. Phone/Fax

Practice location:
  • Phone: 517-299-1273
  • Fax: 517-507-4897
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501301999
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: