Provider Demographics
NPI:1255332060
Name:BOEHNKE, WILLIAM H (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:H
Last Name:BOEHNKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 NORRIE DR
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-1523
Mailing Address - Country:US
Mailing Address - Phone:775-885-2616
Mailing Address - Fax:
Practice Address - Street 1:604 W WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3845
Practice Address - Country:US
Practice Address - Phone:775-882-5001
Practice Address - Fax:775-882-5015
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003413008Medicaid
NV003413008Medicaid