Individual
DR. EMILY LYNN BOGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, ATC
Contact information
Practice address
209 9TH ST STE 101, ROCKFORD, IL 61104-2235
(779) 696-4590
Mailing address
209 9TH ST STE 101, ROCKFORD, IL 61104-2235
(779) 696-4590
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070025130
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070025130
LICENSED PHYSICAL THERAPIST
IL
Enumeration date
09/23/2020
Last updated
09/23/2020
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