Provider Demographics
NPI:1386894152
Name:BOGARDUS, BARBARA ELAINE (PTA)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ELAINE
Last Name:BOGARDUS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2422
Mailing Address - Country:US
Mailing Address - Phone:717-367-1377
Mailing Address - Fax:717-367-1290
Practice Address - Street 1:320 S MARKET ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2422
Practice Address - Country:US
Practice Address - Phone:717-367-1377
Practice Address - Fax:717-367-1290
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000463L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant