Provider Demographics
NPI:1346342805
Name:BOEHM, KATHRYN S (PT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:BOEHM
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 1:530 LAKEHURST RD
Mailing Address - Street 2:SUITE 202 & 204
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8063
Mailing Address - Country:US
Mailing Address - Phone:732-349-1201
Mailing Address - Fax:732-349-1202
Practice Address - Street 1:530 LAKEHURST RD
Practice Address - Street 2:SUITE 202 & 204
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8063
Practice Address - Country:US
Practice Address - Phone:732-349-1201
Practice Address - Fax:732-349-1202
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPTDPTQA08925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066046PMVMedicare ID - Type UnspecifiedMEDICARE PT PROVIDER #