MEDICARE: RHEA JANE BOSCOLO 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	002212	CT

General Provider Information

NPI Number	:	1770853822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHEA JANE BOSCOLO P.T.

Provider Business Mailing Address
First Line	:	117 STOCKING BROOK RD
Second Line	:
City	:	KENSINGTON
State	:	CT
Zip	:	06037-3429
Country	:	US
Telephone Number	:	860-828-9637
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 MAIN ST
Second Line	:
City	:	PORTLAND
State	:	CT
Zip	:	06480-1561
Country	:	US
Telephone Number	:	860-342-0370
Fax Number	:

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

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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