Provider Demographics
NPI:1346627221
Name:BOEH, DEREK (DPT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:BOEH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-853-4731
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:6020 S MASON MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3706
Practice Address - Country:US
Practice Address - Phone:513-204-6490
Practice Address - Fax:513-204-6499
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist