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General NPI Number Information
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NPI Number | 1922467471
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Entity Type | Individual
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Provider Name | TIFFANY MARIE BOGLE DPT
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Gender | Male
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1427 W BADDOUR PKWY STE A
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City | LEBANON
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State | TN
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Zip | 37087-3062
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Country | US
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Telephone | 615-444-1408
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Fax | 615-444-1393
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Provider Business Mailing Address
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Address Line | 112 BRADFORD BLVD SUITE 500
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City | GORDONSVILLE
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State | TN
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Zip | 38563-4600
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Country | US
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Telephone | 615-683-3010
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Fax | 615-683-3016
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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 | PT10753
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License Number State | TN
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