=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326868308
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA RAYLENE BOGGS LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2024
-----------------------------------------------------
Last Update Date | 10/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 W 41ST ST STE D
-----------------------------------------------------
City | SAND SPRINGS
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74063-2726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-381-0783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9630 GLIDDEN AVE
-----------------------------------------------------
City | SAPULPA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74066-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-855-7077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 196470
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------