Provider Demographics
NPI:1245870187
Name:BOEHLERT, PATRICIA JEAN
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEAN
Last Name:BOEHLERT
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 1:4401 MEDICAL CENTER DR STE 401
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6603
Mailing Address - Country:US
Mailing Address - Phone:315-329-2550
Mailing Address - Fax:315-744-1947
Practice Address - Street 1:4401 MEDICAL CENTER DR STE 401
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6603
Practice Address - Country:US
Practice Address - Phone:315-329-2550
Practice Address - Fax:315-744-1947
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010847-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist