Provider Demographics
NPI:1225519374
Name:BOGUSCH, JEAN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:BOGUSCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 S PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6435
Mailing Address - Country:US
Mailing Address - Phone:316-253-0743
Mailing Address - Fax:
Practice Address - Street 1:21005 S SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-9346
Practice Address - Country:US
Practice Address - Phone:316-253-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017026430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist