Provider Demographics
NPI:1932640794
Name:BOHARA, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BOHARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 1/2 HERSCHEL AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3093
Mailing Address - Country:US
Mailing Address - Phone:214-734-1575
Mailing Address - Fax:
Practice Address - Street 1:4103 1/2 HERSCHEL AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3093
Practice Address - Country:US
Practice Address - Phone:214-734-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist