Provider Demographics
NPI:1417236043
Name:BOGGS, RHYMES WALKER (DPT)
Entity Type:Individual
Prefix:DR
First Name:RHYMES
Middle Name:WALKER
Last Name:BOGGS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 FAIRFIELD AVE
Mailing Address - Street 2:APT 109
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4771
Mailing Address - Country:US
Mailing Address - Phone:318-512-1271
Mailing Address - Fax:
Practice Address - Street 1:3820 FAIRFIELD AVE
Practice Address - Street 2:APT 109
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-4771
Practice Address - Country:US
Practice Address - Phone:318-512-1271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-13
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist