Healthcare Provider Details

I. General information

NPI: 1710353743
Provider Name (Legal Business Name): PADAM BOGATI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 LILLY RD NE STE 240
OLYMPIA WA
98506-5117
US

IV. Provider business mailing address

615 LILLY RD NE STE 240
OLYMPIA WA
98506-5117
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-3850
  • Fax: 360-359-4726
Mailing address:
  • Phone: 360-413-3850
  • Fax: 360-359-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number63480
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61538562
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: