Active NPI
Courtney Bogan
- Physical Therapist
- Mountainburg, AR
National Provider Identifier
1205453255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4199
- Practice address
- 9820 Dollard Rd
Mountainburg, AR 72946-3350 - Phone
- (479) 222-1425
- NPI assigned
- Jun 25, 2020
- Last updated
- Jun 25, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4199 | AR | Primary |
Addresses
Primary practice location
9820 Dollard Rd
Mountainburg, AR 72946-3350
Mailing address
3210 Osprey Cir
Alma, AR 72921-7394
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200831001308 | AR | Practitioner - Physical Therapist in Private Practice | 2567889926 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4199 | AR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mobile Fees of Nwa | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Speech-Language Pathologist
- Fort Smith, AR
- NPI 1275359788
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593043200000",
"number": "1205453255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3210 OSPREY CIR",
"city": "ALMA",
"state": "AR",
"postal_code": "729217394",
"fax_number": "855-212-0581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9820 DOLLARD RD",
"city": "MOUNTAINBURG",
"state": "AR",
"postal_code": "729463350",
"telephone_number": "479-222-1425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGAN",
"first_name": "COURTNEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-25",
"last_updated": "2020-06-25",
"certification_date": "2020-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "4199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountainburg, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.