Active NPI
Richard Bohannon, P.T.
- Physical Therapist
- West Hartford, CT
National Provider Identifier
1992990550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 003777
- Practice address
- 130 Middlebrook Rd
West Hartford, CT 06119-1059 - Phone
- (860) 233-1033
- Fax
- (860) 233-0609
- NPI assigned
- Sep 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 003777 | CT | Primary |
Addresses
Primary practice location
130 Middlebrook Rd
West Hartford, CT 06119-1059
Mailing address
130 Middlebrook Rd
West Hartford, CT 06119-1059
Phone (860) 233-1033
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003777 | CT | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189123200000",
"number": "1992990550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 MIDDLEBROOK RD",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061191059",
"telephone_number": "860-233-1033",
"fax_number": "860-233-0609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 MIDDLEBROOK RD",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061191059",
"telephone_number": "860-233-1033",
"fax_number": "860-233-0609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOHANNON",
"first_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-07",
"last_updated": "2007-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "003777",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.