Provider Demographics
NPI:1265584551
Name:BOGARDUS, JENNIFER MURPHY (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MURPHY
Last Name:BOGARDUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3786
Mailing Address - Country:US
Mailing Address - Phone:203-865-6784
Mailing Address - Fax:203-865-6788
Practice Address - Street 1:199 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3786
Practice Address - Country:US
Practice Address - Phone:203-865-6784
Practice Address - Fax:203-865-6788
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650001370Medicare PIN