Individual
SHANNON BOGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2106 S LOIS AVE, TAMPA, FL 33629-5659
(813) 287-9370
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT12643
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00465914
RAILROAD MEDICARE
FL
Enumeration date
08/30/2006
Last updated
12/13/2010
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