Healthcare Provider Details

I. General information

NPI: 1245959329
Provider Name (Legal Business Name): JOHN BOHARD PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18040 SW LOWER BOONES FERRY RD STE 200
TIGARD OR
97224-7259
US

IV. Provider business mailing address

751 SW CALDEW DR
PORTLAND OR
97219-2136
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-0680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

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: