Healthcare Provider Details

I. General information

NPI: 1285299115
Provider Name (Legal Business Name): BRITTANY BOEHNLEIN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 ALLENTOWN RD
LIMA OH
45807-2140
US

IV. Provider business mailing address

1880 N PERRY ST STE 100
OTTAWA OH
45875-1164
US

V. Phone/Fax

Practice location:
  • Phone: 419-221-0904
  • Fax: 419-221-3018
Mailing address:
  • Phone: 419-523-9003
  • Fax: 419-523-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016026
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: