Physician Compare National (NPI:1326105495)

HEALTHCARE PROVIDER: BERT BOVARD BOLDT II BS PT

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1326105495
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8224348305
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151102000830
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOLDT
	Individual professional last name
Provider First Name	BERT
	Individual professional first name
Provider Name Suffix Text	II
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1969
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	132 SALEM CT
	Group Practice or individual's line 1 address
City	TALLAHASSEE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	323012810
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y