=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437679552
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL BOCCARD PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2017
-----------------------------------------------------
Last Update Date | 06/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 604 OLD LIVERPOOL RD STE 2
-----------------------------------------------------
City | LIVERPOOL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13088-6033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-635-5000
-----------------------------------------------------
Fax | 315-451-1752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7687 FRONTAGE RD
-----------------------------------------------------
City | CICERO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13039-8921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-635-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | APP-000085153
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 041643
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------