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NPI Code Detail

MEDICARE: ANNA BOLTON D.P.T.

MEDICARE: ANNA BOLTON D.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
12251G0304XGeriatric Physical Therapist11-05383KS

General Provider Information

NPI Number : 1780037481
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA BOLTON D.P.T.
Provider Business Mailing Address
First Line : 400 N MCCLURG CT APT 2215
Second Line :
City : CHICAGO
State : IL
Zip : 60611-4343
Country : US
Telephone Number : 913-707-4343
Fax Number :
Provider Business Practice Location Address
First Line : 929 W FOSTER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1491
Country : US
Telephone Number : 773-433-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2016
Last Update Date : 07/18/2016

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