Provider Demographics
NPI:1801065735
Name:BOGUCKI, ARVILLA RUTH (CMT)
Entity type:Individual
Prefix:
First Name:ARVILLA
Middle Name:RUTH
Last Name:BOGUCKI
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 1:602 W ADAMS
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-2611
Mailing Address - Country:US
Mailing Address - Phone:574-674-4258
Mailing Address - Fax:
Practice Address - Street 1:602 W ADAMS
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-2611
Practice Address - Country:US
Practice Address - Phone:574-674-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist