Provider Demographics
NPI:1922467471
Name:BOGLE, TIFFANY MARIE (DPT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:BOGLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:MARIE
Other - Last Name:MCNAMEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 BRADFORD BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GORDONSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38563-4600
Mailing Address - Country:US
Mailing Address - Phone:615-683-3010
Mailing Address - Fax:615-683-3016
Practice Address - Street 1:1427 W BADDOUR PKWY STE A
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3062
Practice Address - Country:US
Practice Address - Phone:615-444-1408
Practice Address - Fax:615-444-1393
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT10753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist