Provider Demographics
NPI:1598858516
Name:BOHORFOUSH, ELIZABETH PLACE (MSPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PLACE
Last Name:BOHORFOUSH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:HELEN
Other - Middle Name:ELIZABETH
Other - Last Name:PLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:2000 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2110
Practice Address - Country:US
Practice Address - Phone:205-801-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL418961932OtherTRICARE
AL6400002OtherUNITED HEALTHCARE
AL51520641OtherBLUE CROSS
AL51520641Medicare ID - Type Unspecified
Q13369Medicare UPIN