Provider Demographics
NPI:1700867256
Name:BOEHM, SUSAN ELIZABETH (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:BOEHM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 CHAMBERS RD STE B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-1329
Mailing Address - Country:US
Mailing Address - Phone:720-859-6139
Mailing Address - Fax:720-859-3294
Practice Address - Street 1:3449 CHAMBERS RD STE B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-1329
Practice Address - Country:US
Practice Address - Phone:720-859-6139
Practice Address - Fax:720-859-3294
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2275225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA102501Medicare PIN
COA102501Medicare PIN
NVV101218Medicare PIN