Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1168173 | TX |
NPI | 1043393846 |
---|---|
Provider Name | Emily Rose Bohn |
First Address | Amarillo, TX 79106 |
Second Address | Lubbock, TX 79414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 25/07/2018 |