Provider Demographics
NPI:1396707469
Name:BOSTIC, DAWN M (PT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:BOSTIC
Suffix:
Gender:F
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:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-304-8431
Mailing Address - Fax:
Practice Address - Street 1:8923 SOPER HILL RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-6882
Practice Address - Country:US
Practice Address - Phone:425-339-5419
Practice Address - Fax:425-339-4219
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8928454OtherL&I CRIME VICTIMS
WA650021104OtherRAILROAD MEDICARE
WA3824BOOtherREGENCE BLUE SHIELD
WA8928861OtherL & I CRIME VICTIMS
WA8742BOOtherREGENCE BLUE SHIELD
WA4517914OtherAETNA
WA5587BOOtherREGENCE BLUE SHIELD
WA911745305-98208-B002OtherTRICARE
WA911745305-98223-A007OtherTRICARE
WA0145708OtherDEPT. OF LABOR & INDUSTRY
WA8336315Medicaid
WA8928454OtherL&I CRIME VICTIMS