MEDICARE: MICHAEL P BOME PT,MA,ECS

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	2251E1300X	Clinical Electrophysiology Physical Therapist	3845	NY

General Provider Information

NPI Number	:	1134291164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL P BOME PT,MA,ECS

Provider Business Mailing Address
First Line	:	3157 HEARN DR
Second Line	:
City	:	MARIETTA
State	:	NY
Zip	:	13110-3161
Country	:	US
Telephone Number	:	315-636-7789
Fax Number	:

Provider Business Practice Location Address
First Line	:	3157 HEARN DR
Second Line	:
City	:	MARIETTA
State	:	NY
Zip	:	13110-3161
Country	:	US
Telephone Number	:	315-636-7789
Fax Number	:

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	10/20/2011

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