MEDICARE: MR. THOMAS C. BOEKE PT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305003259	VA
2	225100000X	Physical Therapist	PT870722	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	245010	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1043271836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS C. BOEKE PT, ATC

Provider Business Mailing Address
First Line	:	600 PENNSYLVANIA AVE SE STE 202
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-4344
Country	:	US
Telephone Number	:	202-543-9400
Fax Number	:	202-543-8990

Provider Business Practice Location Address
First Line	:	600 PENNSYLVANIA AVE SE STE 202
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-4344
Country	:	US
Telephone Number	:	202-543-9400
Fax Number	:	202-543-8990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	03/20/2019

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