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NPI Code Detail

MEDICARE: TOLLIE M BOHL DPT

MEDICARE: TOLLIE M BOHL 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
1225100000XPhysical Therapist6523OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417245358
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOLLIE M BOHL DPT
Provider Business Mailing Address
First Line : PO BOX 3158
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3158
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1627 WOODS CT
Second Line :
City : HOOD RIVER
State : OR
Zip : 97031-2915
Country : US
Telephone Number : 541-386-9511
Fax Number : 866-860-8070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2011
Last Update Date : 01/13/2016

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1407928344 — MR. THOMAS DAVID MOLINE PT, MS,
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Directions to “ TOLLIE M BOHL DPT” Practice Location

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