MEDICARE: MICHAEL BOMAN PT, 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
2	2251S0007X	Sports Physical Therapist	PT31170	FL
3	2251X0800X	Orthopedic Physical Therapist	PT31170	FL

General Provider Information

NPI Number	:	1336514009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BOMAN PT, DPT

Provider Business Mailing Address
First Line	:	1807 SE 8TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-2399
Country	:	US
Telephone Number	:	727-954-0125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 SE 8TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-2399
Country	:	US
Telephone Number	:	727-954-0125
Fax Number	:

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

Provider Enumeration Date	:	12/07/2015
Last Update Date	:	05/25/2023

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