Provider Demographics
NPI:1134668676
Name:BOHLMANN, DEBORA
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:BOHLMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:YOSEMITE NTPK
Mailing Address - State:CA
Mailing Address - Zip Code:95389-0947
Mailing Address - Country:US
Mailing Address - Phone:916-479-2411
Mailing Address - Fax:
Practice Address - Street 1:9014 LOST ARROW ROAD
Practice Address - Street 2:
Practice Address - City:YOSEMITE NTPK
Practice Address - State:CA
Practice Address - Zip Code:95389
Practice Address - Country:US
Practice Address - Phone:916-479-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62758225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist