Provider Demographics
NPI:1215918982
Name:BOHANNAN, DONNA M (PT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:BOHANNAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 E 9TH AVE
Mailing Address - Street 2:ATTN ROSE INPATIENT REHAB
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3908
Mailing Address - Country:US
Mailing Address - Phone:303-320-2818
Mailing Address - Fax:303-320-7117
Practice Address - Street 1:4567 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3908
Practice Address - Country:US
Practice Address - Phone:303-320-2818
Practice Address - Fax:303-320-7117
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86723251OtherMEDICAID PRACTICE GROUP #
CO066615OtherMEDICARE GROUP #
CO50272357Medicaid