Provider Demographics
NPI:1063618270
Name:BOHNAKER, ROBERT ALAN (PTA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:BOHNAKER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 STATESMAN DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2414
Mailing Address - Country:US
Mailing Address - Phone:187-745-3516
Mailing Address - Fax:888-352-1529
Practice Address - Street 1:5001 STATESMAN DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2414
Practice Address - Country:US
Practice Address - Phone:187-745-3516
Practice Address - Fax:888-352-1529
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6501A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036550Medicare ID - Type Unspecified