MEDICARE: KRISTA BOHLEN MP.T.

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	8328	CO

General Provider Information

NPI Number	:	1316098262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA BOHLEN MP.T.

Provider Business Mailing Address
First Line	:	455 OCELOT DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6160 TUTT BLVD STE 240
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3502
Country	:	US
Telephone Number	:	719-596-0880
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	10/25/2016

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