Basic Information
| Provider Information | |||||||||
| NPI: | 1881957884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOGLE | ||||||||
| FirstName: | KIRK-JOHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 717 HURLEY PARK DR | ||||||||
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| City: | SEAFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199731319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026829373 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 E CARROLL ST | ||||||||
| Address2: | ST 3 | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105466400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2012 | ||||||||
| LastUpdateDate: | 06/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | A3159 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.