Provider Demographics
NPI:1629053178
Name:BOGDEN, ROBYN SUE (PT)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:SUE
Last Name:BOGDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9828 E BURNSIDE ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2354
Mailing Address - Country:US
Mailing Address - Phone:503-254-3424
Mailing Address - Fax:503-254-3635
Practice Address - Street 1:9828 E BURNSIDE ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2354
Practice Address - Country:US
Practice Address - Phone:503-254-3424
Practice Address - Fax:503-254-3635
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003264225100000X
OR01049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR019250Medicaid
ORP00836820OtherRR MEDICARE
OR119343Medicare ID - Type Unspecified
ORP00836820OtherRR MEDICARE