Provider Demographics
NPI:1912278425
Name:BOHR, PATTY JEAN (PTA)
Entity Type:Individual
Prefix:MS
First Name:PATTY
Middle Name:JEAN
Last Name:BOHR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CARILLO ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3030
Mailing Address - Country:US
Mailing Address - Phone:321-674-0430
Mailing Address - Fax:
Practice Address - Street 1:5405 BABCOCK ST NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5020
Practice Address - Country:US
Practice Address - Phone:321-722-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 2071225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant