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NPI Code Detail

MEDICARE: BRADLEY RAY BOGGESS

MEDICARE:   BRADLEY RAY BOGGESS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2009004521MO

General Provider Information

NPI Number : 1255684379
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY RAY BOGGESS
Provider Business Mailing Address
First Line : 6301 N. LUCERNE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64151-3105
Country : US
Telephone Number : 816-569-1802
Fax Number : 816-569-2099
Provider Business Practice Location Address
First Line : 6301 N. LUCERNE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64151-3105
Country : US
Telephone Number : 816-569-1802
Fax Number : 816-569-2099
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2012
Last Update Date : 10/26/2012

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Directions to “ BRADLEY RAY BOGGESS ” Practice Location

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