Provider Demographics
NPI:1124120308
Name:BOSHEARS, PATRICIA J (PTA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:BOSHEARS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:PATSY
Other - Middle Name:JEAN
Other - Last Name:GOLEACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OWNER AND PTA
Mailing Address - Street 1:1304 PAPERMILL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1903
Mailing Address - Country:US
Mailing Address - Phone:865-588-6789
Mailing Address - Fax:865-588-5303
Practice Address - Street 1:1304 PAPERMILL POINTE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1903
Practice Address - Country:US
Practice Address - Phone:865-588-6789
Practice Address - Fax:865-588-5303
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4498565174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist