MEDICARE: PATRICK BOULEY 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	5763	AZ

General Provider Information

NPI Number	:	1649293481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK BOULEY P.T.

Provider Business Mailing Address
First Line	:	2312 N ROSEMONT BLVD
Second Line	:	SUITE 103
City	:	TUCSON
State	:	AZ
Zip	:	85712-6114
Country	:	US
Telephone Number	:	520-232-9797
Fax Number	:	520-232-9799

Provider Business Practice Location Address
First Line	:	2312 N ROSEMONT BLVD
Second Line	:	SUITE 103
City	:	TUCSON
State	:	AZ
Zip	:	85712-6114
Country	:	US
Telephone Number	:	520-232-9797
Fax Number	:	520-232-9799

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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Directions to “ PATRICK BOULEY P.T.” Practice Location

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