MEDICARE: TRISTAN BOALDIN 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	03757	IA

General Provider Information

NPI Number	:	1275503757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISTAN BOALDIN DPT

Provider Business Mailing Address
First Line	:	5100 PRAIRIE PKWY
Second Line	:	SUITE 104
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-8155
Country	:	US
Telephone Number	:	319-222-2901
Fax Number	:	319-222-2991

Provider Business Practice Location Address
First Line	:	5100 PRAIRIE PKWY
Second Line	:	SUITE 104
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-8155
Country	:	US
Telephone Number	:	319-222-2901
Fax Number	:	319-222-2991

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	01/05/2017

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