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General NPI Number Information
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NPI Number | 1720462187
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Entity Type | Individual
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Provider Name | ANNA BOGE L.M.T., M.M.P.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1395 JORDAN ST
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-4759
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Country | US
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Telephone | 319-774-3811
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 130TH ST
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City | WEST LIBERTY
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State | IA
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Zip | 52776-9121
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Country | US
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Telephone | 563-564-0720
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 006773
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License Number State | IA
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