Provider Demographics
NPI:1700166618
Name:BOGERT, MICHELLE ALISEMARIE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALISEMARIE
Last Name:BOGERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ALISEMARIE
Other - Last Name:KEYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3940 E ROSEMONTE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3285
Mailing Address - Country:US
Mailing Address - Phone:636-634-1606
Mailing Address - Fax:
Practice Address - Street 1:539 E GLENDALE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4900
Practice Address - Country:US
Practice Address - Phone:602-241-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic