Provider Demographics
NPI:1629703103
Name:BOZANICH, TORI NICOLE (ATC)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:NICOLE
Last Name:BOZANICH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25420 STEPHVON WAY
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-2054
Mailing Address - Country:US
Mailing Address - Phone:951-764-0232
Mailing Address - Fax:
Practice Address - Street 1:25420 STEPHVON WAY
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-2054
Practice Address - Country:US
Practice Address - Phone:951-764-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer