MEDICARE: KATHLEEN S BOCHNOWSKI PT

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	5111951-2401	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033205042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN S BOCHNOWSKI PT

Provider Business Mailing Address
First Line	:	PO BOX 681927
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84068-1927
Country	:	US
Telephone Number	:	435-575-0345
Fax Number	:	435-575-0346

Provider Business Practice Location Address
First Line	:	6030 MARKET ST
Second Line	:	SUITE 135
City	:	PARK CITY
State	:	UT
Zip	:	84098-7927
Country	:	US
Telephone Number	:	435-575-0345
Fax Number	:	435-575-0346

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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