MEDICARE: MR. MICHAEL EUGENE BOGARD PT

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
1	225100000X	Physical Therapist	2223	TN

General Provider Information

NPI Number	:	1801968854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL EUGENE BOGARD PT

Provider Business Mailing Address
First Line	:	PO BOX 441
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320
Country	:	US
Telephone Number	:	731-584-0942
Fax Number	:	731-584-0942

Provider Business Practice Location Address
First Line	:	77 EAST LAKE ST
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320
Country	:	US
Telephone Number	:	731-584-0942
Fax Number	:	731-584-0942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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