Robert Kelly Bohannon, PTA
Individual provider Active NPI Physical Therapy Assistant · Great Falls, MT
NPI 1952808677 · NPPES record last updated Apr 9, 2018
Key facts
- NPI
- 1952808677
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- PTP-PTA-LIC-9399 (MT)
- Practice address
- 500 15TH Ave S
Great Falls, MT 59405-4324 - Phone
- (406) 455-2200
- NPI assigned
- Apr 9, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTP-PTA-LIC-9399 | MT | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTP-PTA-LIC-9399 | MT | Yes |
Addresses
Primary practice location
500 15TH Ave S
Great Falls, MT 59405-4324
Mailing address
500 15TH Ave S
Great Falls, MT 59405-4324
Phone (406) 455-2200
Other providers in Great Falls, MT
- Ryan Boer
- Boes Eye Care
- David A Boes
- Makenna Bogen
- Jeanie Bohall
- David C Boharski
- Kathryn Lynnette Bohks
- Cody Wayne Bohlke
- Molly Boland
- Paul Edward Boland
All providers in Great Falls, MT · Physical Therapy Assistant in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.