Active NPI
Christopher Michael Bolen, D.P.T.
- Physical Therapist
- Marianna, FL
National Provider Identifier
1487976833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT24998
- Practice address
- 4970 Highway 90
Marianna, FL 32446-6802 - Phone
- (850) 718-5620
- NPI assigned
- Feb 25, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | 24998 | FL | |
| Physical Therapist | 225100000X | PT24998 | FL | Primary |
Addresses
Primary practice location
4970 Highway 90
Marianna, FL 32446-6802
Mailing address
4970 Highway 90
Marianna, FL 32446-6802
Phone (850) 718-5620
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24998 | FL | MD | Military Health Care Provider |
| PT24998 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673395200000",
"number": "1487976833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4970 HIGHWAY 90",
"city": "MARIANNA",
"state": "FL",
"postal_code": "324466802",
"telephone_number": "850-718-5620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4970 HIGHWAY 90",
"city": "MARIANNA",
"state": "FL",
"postal_code": "324466802",
"telephone_number": "850-718-5620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLEN",
"first_name": "CHRISTOPHER",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "D.P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-25",
"last_updated": "2023-01-11",
"certification_date": "2023-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "FL",
"license": "24998",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT24998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marianna, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.