Provider Demographics
NPI:1548142995
Name:BOHRER, ANISSA PAIGE X
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:PAIGE
Last Name:BOHRER
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:PADEN CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26159-1409
Mailing Address - Country:US
Mailing Address - Phone:304-771-3972
Mailing Address - Fax:
Practice Address - Street 1:210 CHARLES ST
Practice Address - Street 2:
Practice Address - City:SISTERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26175-1202
Practice Address - Country:US
Practice Address - Phone:304-447-2453
Practice Address - Fax:304-652-1960
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000220225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant