Provider Demographics
NPI:1669596110
Name:BOGOTT, ELISHA (CMT)
Entity type:Individual
Prefix:MS
First Name:ELISHA
Middle Name:
Last Name:BOGOTT
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 WAKEROBIN LN
Mailing Address - Street 2:#A204
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-4157
Mailing Address - Country:US
Mailing Address - Phone:970-310-5094
Mailing Address - Fax:
Practice Address - Street 1:1047 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4844
Practice Address - Country:US
Practice Address - Phone:970-310-5094
Practice Address - Fax:970-667-5089
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist