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NPI Code Detail

MEDICARE: SHANNON BOGLE PT

MEDICARE: SHANNON BOGLE 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
12251X0800XOrthopedic Physical TherapistPT12643FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00465914OTHERFLRAILROAD MEDICARE

General Provider Information

NPI Number : 1851401582
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON BOGLE PT
Provider Business Mailing Address
First Line : 13020 N TELECOM PKWY
Second Line :
City : TEMPLE TERRACE
State : FL
Zip : 33637-0925
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2106 S LOIS AVE
Second Line :
City : TAMPA
State : FL
Zip : 33629-5659
Country : US
Telephone Number : 813-287-9370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 12/13/2010

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Directions to “ SHANNON BOGLE PT” Practice Location

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