Provider Demographics
NPI:1538805262
Name:BOLES PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:BOLES PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-450-0371
Mailing Address - Street 1:8091 WILD LEMON LN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9792
Mailing Address - Country:US
Mailing Address - Phone:315-450-0371
Mailing Address - Fax:
Practice Address - Street 1:8091 WILD LEMON LN
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9792
Practice Address - Country:US
Practice Address - Phone:315-450-0371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty