Provider Demographics
NPI:1265817548
Name:BOGGESS, MADISON LEIGH (DPT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LEIGH
Last Name:BOGGESS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MORGANTOWN ST
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1095
Mailing Address - Country:US
Mailing Address - Phone:304-329-3739
Mailing Address - Fax:304-329-3250
Practice Address - Street 1:421 MORGANTOWN ST
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1095
Practice Address - Country:US
Practice Address - Phone:304-329-3739
Practice Address - Fax:304-329-3250
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV003505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist