Provider Demographics
NPI:1306942198
Name:BOHANNAN, DAVID STEVEN (DPT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STEVEN
Last Name:BOHANNAN
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 1:515 FORREST PARK WAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-5955
Mailing Address - Country:US
Mailing Address - Phone:479-597-8318
Mailing Address - Fax:
Practice Address - Street 1:515 FORREST PARK WAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-5955
Practice Address - Country:US
Practice Address - Phone:479-597-8318
Practice Address - Fax:479-996-5079
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y701OtherBC/BS
ARPT2764OtherPT LICENSE