MEDICARE: JOANELL A BOHMERT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1825	MN

General Provider Information

NPI Number	:	1114282068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANELL A BOHMERT PT

Provider Business Mailing Address
First Line	:	199 PUMA LN
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115-6833
Country	:	US
Telephone Number	:	651-270-9940
Fax Number	:

Provider Business Practice Location Address
First Line	:	688 WILDWOOD RD
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115-1812
Country	:	US
Telephone Number	:	651-429-9947
Fax Number	:	651-429-1029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	08/31/2017

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Directions to “ JOANELL A BOHMERT PT” Practice Location

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