MEDICARE: MR. RICHARD RONALD BOECKMANN 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	2049	AZ

General Provider Information

NPI Number	:	1659478618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD RONALD BOECKMANN PT

Provider Business Mailing Address
First Line	:	3520 E UTOPIA RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3966
Country	:	US
Telephone Number	:	602-867-8335
Fax Number	:

Provider Business Practice Location Address
First Line	:	16421 N TATUM BLVD
Second Line	:	SUITE 208
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3454
Country	:	US
Telephone Number	:	602-923-6600
Fax Number	:	602-923-6611

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. RICHARD RONALD BOECKMANN PT” Practice Location

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