Provider Demographics
NPI:1407311160
Name:BOGAERT, JULIE REBECCA (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:REBECCA
Last Name:BOGAERT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ROTARY DR
Mailing Address - Street 2:
Mailing Address - City:WEST HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1182
Mailing Address - Country:US
Mailing Address - Phone:570-459-6333
Mailing Address - Fax:
Practice Address - Street 1:106 ROTARY DR
Practice Address - Street 2:
Practice Address - City:WEST HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1182
Practice Address - Country:US
Practice Address - Phone:570-459-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist