Tayler Bogert, PT, DPT

Key facts

NPI

1871374751

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

2305215974 (VA)

Practice address

1799 Southcreek One Ste E
Powhatan, VA 23139-7960

Phone

(804) 794-9023

Fax

(804) 794-9373

NPI assigned

Oct 9, 2023

Sex

Male

Sole proprietor

Yes

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 and National Provider Directory roles.

• Powhatan Physical Therapy Corporation Physical Therapist · Powhatan, VA · NPI 1477569200
  NPD SINGLE SPECIALTY

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 9, 2023.

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1871374751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1943 REGIMENT TER",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231137230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1799 SOUTHCREEK ONE STE E",
            "city": "POWHATAN",
            "state": "VA",
            "postal_code": "231397960",
            "telephone_number": "804-794-9023",
            "fax_number": "804-794-9373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGERT",
        "first_name": "TAYLER",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-09",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305215974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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