Provider Demographics
NPI:1215304480
Name:BOEHMKE, NATHAN (DPT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BOEHMKE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 N MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3432
Mailing Address - Country:US
Mailing Address - Phone:414-258-3600
Mailing Address - Fax:262-898-3933
Practice Address - Street 1:933 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3432
Practice Address - Country:US
Practice Address - Phone:414-258-3600
Practice Address - Fax:262-898-3933
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070028740225100000X
WI13220-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist