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General NPI Number Information
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NPI Number | 1568267516
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Entity Type | Individual
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Provider Name | MATTHEW BOHAN
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Gender | Male
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 4700 MORTENSEN RD STE 101
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City | AMES
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State | IA
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Zip | 50014-5580
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Country | US
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Telephone | 515-337-1037
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Fax |
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Provider Business Mailing Address
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Address Line | 604 LIBERTY ST STE 227
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City | PELLA
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State | IA
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Zip | 50219-1776
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 131027
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License Number State | IA
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