Provider Demographics
NPI:1306923339
Name:BOHLIN, BECKY JO (DPT)
Entity type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:JO
Last Name:BOHLIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:JO
Other - Last Name:LANGFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:17307 SE 272ND ST STE 126
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5306
Practice Address - Country:US
Practice Address - Phone:425-690-3521
Practice Address - Fax:425-690-9521
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009203225100000X
WAPT 9203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8360588Medicaid
WA8850734Medicare PIN
WA8360588Medicaid