MEDICARE: ANNE MARGARET BOBERSKI

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	8205	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8205	OTHER	TN	TENNESSEE

General Provider Information

NPI Number	:	1194203091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE MARGARET BOBERSKI

Provider Business Mailing Address
First Line	:	2805 CHARLES BRYAN RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-4756
Country	:	US
Telephone Number	:	901-384-3386
Fax Number	:	901-384-3726

Provider Business Practice Location Address
First Line	:	2805 CHARLES BRYAN RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-4756
Country	:	US
Telephone Number	:	901-384-3386
Fax Number	:	901-384-3726

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

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	08/02/2018

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