Individual
BLAKE LOGAN BOHANAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
4589 KINGSTON PIKE, KNOXVILLE, TN 37919-5229
(865) 250-9300
Mailing address
3904 SCHAAD RD, KNOXVILLE, TN 37921-2114
(865) 250-9300
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13261
TN
Other
Enumeration date
01/19/2021
Last updated
01/19/2021
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