MEDICARE: KRISTY BOLHA D.P.T

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	PT 26689	FL

General Provider Information

NPI Number	:	1073944682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY BOLHA D.P.T

Provider Business Mailing Address
First Line	:	247 SE 6TH AVE
Second Line	:	STE 2
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5208
Country	:	US
Telephone Number	:	561-278-6055
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 SE 6TH AVE
Second Line	:	STE 2
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5208
Country	:	US
Telephone Number	:	561-278-6055
Fax Number	:

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

Provider Enumeration Date	:	12/07/2013
Last Update Date	:	01/11/2019

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