MEDICARE: DR. ELIZABETH BOSHEARS PT, DPT

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	PTL.0017020	CO

General Provider Information

NPI Number	:	1720724180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH BOSHEARS PT, DPT

Provider Business Mailing Address
First Line	:	11416 W 38TH AVE
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-3802
Country	:	US
Telephone Number	:	971-506-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 WADSWORTH BLVD STE 425
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-4652
Country	:	US
Telephone Number	:	303-564-1246
Fax Number	:

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

Provider Enumeration Date	:	05/09/2022
Last Update Date	:	05/09/2022

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