Provider Demographics
NPI:1902899875
Name:JOSEPH BOEHM, P.T.
Entity Type:Organization
Organization Name:JOSEPH BOEHM, P.T.
Other - Org Name:LOS OSOS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-528-3002
Mailing Address - Street 1:2115 10TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3244
Mailing Address - Country:US
Mailing Address - Phone:805-528-3002
Mailing Address - Fax:805-528-5341
Practice Address - Street 1:2115 10TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3244
Practice Address - Country:US
Practice Address - Phone:805-528-3002
Practice Address - Fax:805-528-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty