Healthcare Provider Details

I. General information

NPI: 1265645972
Provider Name (Legal Business Name): SALLY LYNN BOHLMANN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N27W5707 LINCOLN BLVD CEDAR SPRINGS HEALTH AND REHAB CENTER
CEDARBURG WI
53012-2852
US

IV. Provider business mailing address

8618 N 53RD ST
BROWN DEER WI
53223-3010
US

V. Phone/Fax

Practice location:
  • Phone: 262-376-7676
  • Fax:
Mailing address:
  • Phone: 414-531-0253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number57-019
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: