Provider Demographics
NPI:1447668330
Name:ROGULJ, BONNIE LEIGH (DPT)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LEIGH
Last Name:ROGULJ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:BONNIE
Other - Middle Name:LEIGH
Other - Last Name:ROGULJ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:190 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4120
Mailing Address - Country:US
Mailing Address - Phone:904-824-8071
Mailing Address - Fax:
Practice Address - Street 1:190 SOUTHPARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4120
Practice Address - Country:US
Practice Address - Phone:904-824-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist