Provider Demographics
NPI:1912048364
Name:BOEHM, DENISE (MS, LMT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:BOEHM
Suffix:
Gender:F
Credentials:MS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6229 SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3721
Mailing Address - Country:US
Mailing Address - Phone:321-961-3846
Mailing Address - Fax:
Practice Address - Street 1:529 E NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5461
Practice Address - Country:US
Practice Address - Phone:321-768-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49001225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist