Provider Demographics
NPI:1609447788
Name:BOHAN, BRIDGET ANNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANNE
Last Name:BOHAN
Suffix:
Gender:F
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 1:860 N DEWITT PL APT 502
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5767
Mailing Address - Country:US
Mailing Address - Phone:315-415-6834
Mailing Address - Fax:
Practice Address - Street 1:610 S MAPLE AVE STE 3500
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2801
Practice Address - Country:US
Practice Address - Phone:708-934-7062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.026001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist