MEDICARE: OLIVIA CATHRYN BOLES DPT

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		TN

General Provider Information

NPI Number	:	1083366561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA CATHRYN BOLES DPT

Provider Business Mailing Address
First Line	:	3309 BONDWOOD CIR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-8904
Country	:	US
Telephone Number	:	423-946-1948
Fax Number	:

Provider Business Practice Location Address
First Line	:	3135 PEOPLES ST STE 404
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-4138
Country	:	US
Telephone Number	:	423-454-1006
Fax Number	:

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

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	01/25/2022

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Directions to “ OLIVIA CATHRYN BOLES DPT” Practice Location

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