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General NPI Number Information
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NPI Number | 1497076244
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Entity Type | Individual
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Provider Name | RICHMOND BOHLER TERRY III L. M. T.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 118 N ROSS ST SUITE 4
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City | AUBURN
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State | AL
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Zip | 36830-4857
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Country | US
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Telephone | 334-826-3842
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Fax |
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Provider Business Mailing Address
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Address Line | 1911 MOORES MILL DR
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City | LANETT
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State | AL
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Zip | 36863-2165
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Country | US
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Telephone | 423-316-3665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 3062
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License Number State | AL
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