MEDICARE: KIMBERLY JANEEN BOZART - DOW

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	3725	NV

General Provider Information

NPI Number	:	1083869283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY JANEEN BOZART - DOW

Provider Business Mailing Address
First Line	:	1550 W CRAIG RD STE 210
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0329
Country	:	US
Telephone Number	:	702-360-9142
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 W CRAIG RD STE 210
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0329
Country	:	US
Telephone Number	:	702-360-9142
Fax Number	:	702-878-2018

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

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	04/22/2024

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