Provider Demographics
NPI:1427397942
Name:BOEHNE, GREGORY MATTHEW (PT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:MATTHEW
Last Name:BOEHNE
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 1:1481 SMUGGLERS CV
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2669
Mailing Address - Country:US
Mailing Address - Phone:609-412-5716
Mailing Address - Fax:
Practice Address - Street 1:1310 37TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4860
Practice Address - Country:US
Practice Address - Phone:772-569-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist