Healthcare Provider Details

I. General information

NPI: 1750424818
Provider Name (Legal Business Name): CHAD J BOHLS M.S. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE SUITE 430
PHOENIX AZ
85016-4872
US

IV. Provider business mailing address

5122 E SHEA BLVD APT 2154
SCOTTSDALE AZ
85254-4680
US

V. Phone/Fax

Practice location:
  • Phone: 602-595-6180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0729
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: