MEDICARE: BAILEY BOICKEN

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	05012519A	IN

General Provider Information

NPI Number	:	1912423864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY BOICKEN

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2222
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	181 DEANNA DR STE C
Second Line	:
City	:	LOWELL
State	:	IN
Zip	:	46356-2402
Country	:	US
Telephone Number	:	219-696-0988
Fax Number	:	219-696-0989

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

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	07/21/2022

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Directions to “ BAILEY BOICKEN ” Practice Location

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