Provider Demographics
NPI:1770918666
Name:BOHMAN, KEVIN JOHN (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:BOHMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2127
Mailing Address - Country:US
Mailing Address - Phone:435-833-0725
Mailing Address - Fax:435-882-2768
Practice Address - Street 1:670 E 3900 S STE 210
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1981
Practice Address - Country:US
Practice Address - Phone:801-266-3979
Practice Address - Fax:801-270-8587
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2023-09-18
Deactivation Date:2022-04-12
Deactivation Code:
Reactivation Date:2023-09-12
Provider Licenses
StateLicense IDTaxonomies
UT8579941-2401225100000X
NV2910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist