MEDICARE: DANIEL JACOB BOSCO 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	18531	FL

General Provider Information

NPI Number	:	1710075163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JACOB BOSCO PT

Provider Business Mailing Address
First Line	:	11 EAGLE ROCK AVE
Second Line	:	STE 201
City	:	EAST HANOVER
State	:	NJ
Zip	:	07936-3167
Country	:	US
Telephone Number	:	239-574-8922
Fax Number	:	239-573-7356

Provider Business Practice Location Address
First Line	:	13670 METROPOLIS AVE
Second Line	:	SUITE 103
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4346
Country	:	US
Telephone Number	:	239-561-0700
Fax Number	:	239-561-5643

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	05/24/2016

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