Provider Demographics
NPI:1689874695
Name:BOHAN, MAUREEN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:BOHAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SILVERLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8410
Mailing Address - Country:US
Mailing Address - Phone:760-704-6883
Mailing Address - Fax:
Practice Address - Street 1:1950 SILVERLEAF CIR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8410
Practice Address - Country:US
Practice Address - Phone:760-704-6883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6541225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant