MEDICARE: KAITLIN BOGUE DPT

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	P20748	NC

General Provider Information

NPI Number	:	1821764416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN BOGUE DPT

Provider Business Mailing Address
First Line	:	4140 FERNCREEK DR STE 801
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-2572
Country	:	US
Telephone Number	:	910-710-5051
Fax Number	:	910-223-6233

Provider Business Practice Location Address
First Line	:	4140 FERNCREEK DR STE 801
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-2572
Country	:	US
Telephone Number	:	910-710-5051
Fax Number	:	910-223-6233

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

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	02/11/2026

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Directions to “ KAITLIN BOGUE DPT” Practice Location

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