1902899875 NPI number — JOSEPH BOEHM, P.T.

Table of content: (NPI 1902899875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902899875 NPI number — JOSEPH BOEHM, P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH BOEHM, P.T.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LOS OSOS PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902899875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2115 10TH ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LOS OSOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93402-3244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-528-3002
Provider Business Mailing Address Fax Number:
805-528-5341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2115 10TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LOS OSOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93402-3244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-528-3002
Provider Business Practice Location Address Fax Number:
805-528-5341
Provider Enumeration Date:
08/25/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOEHM
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
805-528-3002

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)