Provider Demographics
NPI:1891336095
Name:BOHENEK, KATHRYN (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BOHENEK
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 1:17985 E SILVER SAGE LN
Mailing Address - Street 2:
Mailing Address - City:RIO VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85263-5333
Mailing Address - Country:US
Mailing Address - Phone:513-314-0652
Mailing Address - Fax:
Practice Address - Street 1:17985 E SILVER SAGE LN
Practice Address - Street 2:
Practice Address - City:RIO VERDE
Practice Address - State:AZ
Practice Address - Zip Code:85263
Practice Address - Country:US
Practice Address - Phone:513-314-0652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09164225100000X
AZ31573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist