MEDICARE: MR. JOE BOLEWICZ 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	PT00007557	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	137312	OTHER	WA	LABOR & INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518960285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOE BOLEWICZ P.T.

Provider Business Mailing Address
First Line	:	9612 270TH ST NW
Second Line	:
City	:	STANWOOD
State	:	WA
Zip	:	98292-1906
Country	:	US
Telephone Number	:	360-629-8043
Fax Number	:	360-629-8053

Provider Business Practice Location Address
First Line	:	9612 270TH ST NW
Second Line	:
City	:	STANWOOD
State	:	WA
Zip	:	98292-1906
Country	:	US
Telephone Number	:	360-629-8043
Fax Number	:	360-629-8053

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/30/2010

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