Provider Demographics
NPI:1447382015
Name:BOGER, MELISSA (ATC, CSCS, NASM-PES)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:
Last Name:BOGER
Suffix:
Gender:F
Credentials:ATC, CSCS, NASM-PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28088 W. NIAGARA STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28088 W. NIAGARA STREET
Practice Address - Street 2:
Practice Address - City:LAKEMOOR
Practice Address - State:IL
Practice Address - Zip Code:60051
Practice Address - Country:US
Practice Address - Phone:708-257-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960015582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer