Provider Demographics
NPI:1831321736
Name:BOHANAN, JEAN L (PT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:BOHANAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:L
Other - Last Name:FREDMUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:427 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1154
Mailing Address - Country:US
Mailing Address - Phone:570-899-6860
Mailing Address - Fax:
Practice Address - Street 1:53 GRAVEL ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18705-3738
Practice Address - Country:US
Practice Address - Phone:570-371-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006742L2251P0200X
PA006742L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics