MEDICARE: NATHAN BOEHMKE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070028740	IL
2	225100000X	Physical Therapist	13220-24	WI

General Provider Information

NPI Number	:	1215304480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN BOEHMKE DPT

Provider Business Mailing Address
First Line	:	933 N MAYFAIR RD
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3432
Country	:	US
Telephone Number	:	414-258-3600
Fax Number	:	262-898-3933

Provider Business Practice Location Address
First Line	:	933 N MAYFAIR RD
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3432
Country	:	US
Telephone Number	:	414-258-3600
Fax Number	:	262-898-3933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	11/22/2024

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