Provider Demographics
NPI:1821178351
Name:BOHNET, JOCELYN E (PT)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:E
Last Name:BOHNET
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 1:8100 SW NYBERG ST
Mailing Address - Street 2:STE 130
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8375
Mailing Address - Country:US
Mailing Address - Phone:503-620-2400
Mailing Address - Fax:503-620-2410
Practice Address - Street 1:7421 SW BRIDGEPORT RD
Practice Address - Street 2:SUITE 215
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7707
Practice Address - Country:US
Practice Address - Phone:503-620-2400
Practice Address - Fax:503-620-2410
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4081225100000X
WA8328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR116669Medicare PIN