Provider Demographics
NPI:1265415004
Name:BOGDEN, DAVID STEPHEN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:STEPHEN
Last Name:BOGDEN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:58147 COLUMBIA RIVER HWY
Practice Address - Street 2:STE A
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-6226
Practice Address - Country:US
Practice Address - Phone:503-397-1914
Practice Address - Fax:503-366-0422
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0895225100000X
WAPT00003263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR019259Medicaid
WA1265415004Medicaid
WAG8892350Medicare PIN
ORR154871Medicare PIN
ORR165661Medicare PIN
ORR154873Medicare PIN
OR104297Medicare PIN