Provider Demographics
NPI:1770763914
Name:BOHN PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BOHN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNANAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-624-6491
Mailing Address - Street 1:20101 PEACHLAND BLVD
Mailing Address - Street 2:STE. 204
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-2180
Mailing Address - Country:US
Mailing Address - Phone:941-624-6491
Mailing Address - Fax:
Practice Address - Street 1:20101 PEACHLAND BLVD
Practice Address - Street 2:STE. 204
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-2180
Practice Address - Country:US
Practice Address - Phone:941-624-6491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6193Medicare PIN