Healthcare Provider Details

I. General information

NPI: 1154533917
Provider Name (Legal Business Name): EMILY JEAN OHLIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 W MENLO DR
BOISE ID
83702-0322
US

IV. Provider business mailing address

2409 W MENLO DR
BOISE ID
83702-0322
US

V. Phone/Fax

Practice location:
  • Phone: 503-314-7521
  • Fax:
Mailing address:
  • Phone: 503-314-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3286
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number4813
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: