MEDICARE: MR. RICHARD PAUL BOZZIO M.P.T.

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	PT10602	CA

General Provider Information

NPI Number	:	1144296633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD PAUL BOZZIO M.P.T.

Provider Business Mailing Address
First Line	:	PO BOX 1914
Second Line	:
City	:	TAHOE CITY
State	:	CA
Zip	:	96145-1914
Country	:	US
Telephone Number	:	530-583-4661
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 N. LAKE BLVD.
Second Line	:
City	:	TAHOE CITY
State	:	CA
Zip	:	96145
Country	:	US
Telephone Number	:	530-583-4661
Fax Number	:

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	07/08/2007

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