Provider Demographics
NPI:1932593449
Name:BOGART, KAITLIN (DPT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:BOGART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LT JOHN OLSEN LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2537
Mailing Address - Country:US
Mailing Address - Phone:631-662-6578
Mailing Address - Fax:
Practice Address - Street 1:21 LT JOHN OLSEN LN
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2537
Practice Address - Country:US
Practice Address - Phone:631-662-6578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11543225100000X
NY038458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist