Provider Demographics
NPI:1508004615
Name:BOGGS, DEVIN SCOTT (LMP)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:SCOTT
Last Name:BOGGS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 25TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-4175
Mailing Address - Country:US
Mailing Address - Phone:253-219-4222
Mailing Address - Fax:
Practice Address - Street 1:4402 25TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-4175
Practice Address - Country:US
Practice Address - Phone:253-219-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA#00023930225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist