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NPI Code Detail

MEDICARE: TIMOTHY ADAM BOLEK PTA

MEDICARE: TIMOTHY ADAM BOLEK PTA
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
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1851511505
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY ADAM BOLEK PTA
Provider Business Mailing Address
First Line : 1060 WALKER AVE NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4375
Country : US
Telephone Number : 616-774-3967
Fax Number :
Provider Business Practice Location Address
First Line : 2161 LEONARD ST NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-3829
Country : US
Telephone Number : 616-453-7715
Fax Number : 616-735-0633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2007
Last Update Date : 04/09/2008

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Directions to “ TIMOTHY ADAM BOLEK PTA” Practice Location

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