Provider Demographics
NPI:1740839265
Name:BOGGS, JANETTE RUTH
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:RUTH
Last Name:BOGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 HIGHWAY S60
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IA
Mailing Address - Zip Code:52590-8508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1208 E CROSS ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-3501
Practice Address - Country:US
Practice Address - Phone:641-856-8651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087978208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation