Justin Henry Bogard, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

046017-01 Issued in NY

Practice address

48 Douglas LN
East Aurora, NY 14052-2124

Phone

(716) 714-7860

NPI assigned

Sep 21, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Ans Optometry, PLLC

  • Medical Specialty Clinic/Center
  • East Aurora, NY
  • NPI 1780452730
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618358400000",
    "number": "1881200145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 8000 DEPT 314",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142670002",
            "telephone_number": "716-213-0772",
            "fax_number": "716-324-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 DOUGLAS LN",
            "city": "EAST AURORA",
            "state": "NY",
            "postal_code": "140522124",
            "telephone_number": "716-714-7860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGARD",
        "first_name": "JUSTIN",
        "middle_name": "HENRY",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-21",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "046017-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06289849",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dorene Marie Bett, M.S. ED.
• Beverly Stewart Physical Therapy
• Marissa Bierl, IBCLC
• Amy Bilson
• Blue Circle Dietetics & Nutrition PC
• Bonnie E. O'Brien, LCSW, PLLC
• David M Bosela, P.T.
• Donna Brahaney, LPN
• Heather Braun Buccieri, DDS MS
• David Allan Braun, DDS

• Physical Therapist in East Aurora, NY
• Providers in East Aurora, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.