Basic Information
| Provider Information | |||||||||
| NPI: | 1659478618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOECKMANN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | RONALD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3520 E UTOPIA RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850503966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028678335 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16421 N TATUM BLVD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850323454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029236600 | ||||||||
| FaxNumber: | 6029236611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2049 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.