Provider Demographics
NPI:1033726971
Name:BOGLE, RASIKA (PTA)
Entity Type:Individual
Prefix:
First Name:RASIKA
Middle Name:
Last Name:BOGLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:RASIKA
Other - Middle Name:
Other - Last Name:BLACKLEDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1003C SPAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-3626
Mailing Address - Country:US
Mailing Address - Phone:352-231-1589
Mailing Address - Fax:
Practice Address - Street 1:1003C SPAIN AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-3626
Practice Address - Country:US
Practice Address - Phone:352-231-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000007314225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant