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General NPI Number Information
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NPI Number | 1558186817
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Entity Type | Individual
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Provider Name | ANDREA KAYE BOGGS PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 6300 BRIARCREST AVE
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City | MEMPHIS
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State | TN
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Zip | 38120-4085
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Country | US
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Telephone | 901-256-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 4933 OLD GREENWOOD RD
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City | FORT SMITH
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State | AR
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Zip | 72903-6906
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10772
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License Number State | TN
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