Provider Demographics
NPI:1285606806
Name:BOHLING, MARK (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:BOHLING
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 OCEAN DRIVE
Mailing Address - Street 2:UNIT 5719
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-5719
Mailing Address - Country:US
Mailing Address - Phone:361-825-3280
Mailing Address - Fax:361-825-3218
Practice Address - Street 1:6300 OCEAN DR UNIT 5719
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-5719
Practice Address - Country:US
Practice Address - Phone:361-825-3280
Practice Address - Fax:361-825-3218
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT 21762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer