MEDICARE: MR. MARC H BOFF ATC, PT, DPT, CSCS

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	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1821065673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARC H BOFF ATC, PT, DPT, CSCS

Provider Business Mailing Address
First Line	:	550 LAKE COOK RD
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-4921
Country	:	US
Telephone Number	:	847-444-8732
Fax Number	:	847-444-8998

Provider Business Practice Location Address
First Line	:	550 LAKE COOK RD
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-4921
Country	:	US
Telephone Number	:	847-444-8732
Fax Number	:	847-444-8998

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	07/08/2007

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