Provider Demographics
NPI:1841699873
Name:BOOGAART, CRISTINA (DPT)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:BOOGAART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:BOLSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:7310 RITCHIE HWY
Mailing Address - Street 2:500
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3065
Mailing Address - Country:US
Mailing Address - Phone:410-766-4047
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HWY
Practice Address - Street 2:500
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3065
Practice Address - Country:US
Practice Address - Phone:410-766-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist