Lisa Joan Bogacki, PT, MPH, ESMT, CCMT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT002931E Issued in PA

Practice address

403 Friendship Dr
Fleetwood, PA 19522-1902

Phone

(610) 823-3518

Fax

(610) 933-0383

NPI assigned

Jul 7, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1992438840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 FRIENDSHIP DR",
            "city": "FLEETWOOD",
            "state": "PA",
            "postal_code": "195221902",
            "telephone_number": "610-823-3518",
            "fax_number": "610-944-0383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 FRIENDSHIP DR",
            "city": "FLEETWOOD",
            "state": "PA",
            "postal_code": "195221902",
            "telephone_number": "610-823-3518",
            "fax_number": "610-933-0383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGACKI",
        "first_name": "LISA",
        "middle_name": "JOAN",
        "credential": "PT, MPH, ESMT, CCMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-07",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT002931E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@forwardmotiontherapeutics.com",
            "affiliation": "N",
            "endpointDescription": "Business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "403 Friendship Dr",
            "city": "Fleetwood",
            "state": "PA",
            "country_code": "US",
            "postal_code": "195221902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Taylor Beeman, LMT
• Sarah Bentley, LPC
• Lisa D Beveridge, LSW
• Bio Aesthetics & Wellness LLC
• Cassandra Chance Davidson Blum, LCSW: CW025688
• Chelsea Boyer, MSOTR/L
• Linda Breidigam, CRNP
• Crystal Lee Brickner, CRNP
• Melissa Ann Broad, PT, DPT
• Brian Brunsell

• Physical Therapist in Fleetwood, PA
• Providers in Fleetwood, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; 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.