MEDICARE: DR. MADELINE C BOSEK 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	2251X0800X	Orthopedic Physical Therapist	2305208400	VA

General Provider Information

NPI Number	:	1043644404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADELINE C BOSEK DPT

Provider Business Mailing Address
First Line	:	285 HYDRAULIC RIDGE RD
Second Line	:	SUITE 4
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-8126
Country	:	US
Telephone Number	:	434-817-0980
Fax Number	:	434-817-0985

Provider Business Practice Location Address
First Line	:	285 HYDRAULIC RIDGE RD
Second Line	:	SUITE 4
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-8126
Country	:	US
Telephone Number	:	434-817-0980
Fax Number	:	434-817-0985

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

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	11/07/2013

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