Provider Demographics
NPI:1578997607
Name:BOEHM, CHAD C (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:C
Last Name:BOEHM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 MEDSKER RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-8509
Mailing Address - Country:US
Mailing Address - Phone:701-527-0073
Mailing Address - Fax:
Practice Address - Street 1:961 MEDSKER RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-8509
Practice Address - Country:US
Practice Address - Phone:701-527-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12446225100000X
WAPT60727805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1804OtherPHYSICAL THERAPIST
OR60351OtherPHYSICAL THERAPIST
WAPT60727805OtherPHYSICAL THERAPIST