MEDICARE: PATRICIA BOLHACK PHYSICAL THERAPIST

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	2265	AZ

General Provider Information

NPI Number	:	1114295714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA BOLHACK PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	1775 E SKYLINE DR
Second Line	:	SUITE 101
City	:	TUCSON
State	:	AZ
Zip	:	85718-9101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 E RIVER RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-6520
Country	:	US
Telephone Number	:	520-408-9868
Fax Number	:

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

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	03/05/2012

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