Doctor Name: | MICHAEL BOULOS |
NPI Number: | 1558471730 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 40QA00569900 |
Business Practice Address: | 350 West St. George Avenue Linden, NJ - 07036 |
Business Phone Number: | 9089256797 |
Business Fax Number: | |
Mailing Address: | 16 Owens Rd, OLD BRIDGE |
State: | NJ |
Postal Code: | 088571862 |
Phone Number: | 9086796808 |
Fax Number: | |
NPI Enumeration Date: | 08/30/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 40QA00569900 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |