Healthcare Provider Details

I. General information

NPI: 1902899875
Provider Name (Legal Business Name): JOSEPH BOEHM, P.T.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 10TH ST SUITE B
LOS OSOS CA
93402-3244
US

IV. Provider business mailing address

2115 10TH ST SUITE B
LOS OSOS CA
93402-3244
US

V. Phone/Fax

Practice location:
  • Phone: 805-528-3002
  • Fax: 805-528-5341
Mailing address:
  • Phone: 805-528-3002
  • Fax: 805-528-5341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH BOEHM
Title or Position: OWNER
Credential: P.T.
Phone: 805-528-3002