Provider Demographics
NPI:1124758339
Name:BOZEMAN, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BOZEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 WYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2233
Mailing Address - Country:US
Mailing Address - Phone:812-968-4156
Mailing Address - Fax:812-948-4164
Practice Address - Street 1:2857 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-1998
Practice Address - Country:US
Practice Address - Phone:812-948-2947
Practice Address - Fax:812-948-4164
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004054A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist