MEDICARE: MR. MICHAEL P BOVARNICK 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	PT5811	FL

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	:	1295738995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL P BOVARNICK PT

Provider Business Mailing Address
First Line	:	6642 NW 25TH CT
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2016
Country	:	US
Telephone Number	:	561-376-8935
Fax Number	:	561-241-7763

Provider Business Practice Location Address
First Line	:	6642 NW 25TH CT
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2016
Country	:	US
Telephone Number	:	561-376-8935
Fax Number	:	561-241-7763

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/31/2016

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Directions to “ MR. MICHAEL P BOVARNICK PT” Practice Location

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