Provider Demographics
NPI:1295738995
Name:BOVARNICK, MICHAEL P (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:BOVARNICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6642 NW 25TH CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2016
Mailing Address - Country:US
Mailing Address - Phone:561-376-8935
Mailing Address - Fax:561-241-7763
Practice Address - Street 1:6642 NW 25TH CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2016
Practice Address - Country:US
Practice Address - Phone:561-376-8935
Practice Address - Fax:561-241-7763
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4723YMedicare ID - Type Unspecified