Individual
ROBERT KELLY BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
500 15TH AVE S, GREAT FALLS, MT 59405-4324
(406) 455-2200
Mailing address
500 15TH AVE S, GREAT FALLS, MT 59405-4324
(406) 455-2200
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTP-PTA-LIC-9399
MT
Other
Enumeration date
04/09/2018
Last updated
04/09/2018
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