Provider Demographics
NPI:1982942918
Name:BOHR, LASHAWNA JACLYN (LMT)
Entity Type:Individual
Prefix:
First Name:LASHAWNA
Middle Name:JACLYN
Last Name:BOHR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2713
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-2713
Mailing Address - Country:US
Mailing Address - Phone:406-240-9799
Mailing Address - Fax:
Practice Address - Street 1:2825 STOCKYARD RD STE A14
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1545
Practice Address - Country:US
Practice Address - Phone:406-240-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2577225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist