MEDICARE: EGLESTON PHYSICAL THERAPY

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	232	MA

General Provider Information

NPI Number	:	1730418450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EGLESTON PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	1951 COLUMBUS AVE
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02119
Country	:	US
Telephone Number	:	617-427-8008
Fax Number	:	617-427-8083

Provider Business Practice Location Address
First Line	:	1951 COLUMBUS AVE
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02119-1048
Country	:	US
Telephone Number	:	617-427-8008
Fax Number	:	617-427-8083

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSE JACOB BOBADILLA
Credential	:
Telephone Number	:	617-427-8008

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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Directions to “EGLESTON PHYSICAL THERAPY ” Practice Location

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