Provider Demographics
NPI:1528489325
Name:BOSTICK, BRITNEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRITNEY
Middle Name:
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:PT, DPT
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 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:204 GUMWOOD DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-6087
Practice Address - Country:US
Practice Address - Phone:757-357-7762
Practice Address - Fax:757-357-7765
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01306715OtherMEDICARE RR PTAN
VAC05954OtherMEDICARE GROUP PTAN
VA1528489325OtherMEDICAID QMB ONLY
VA1528489325OtherMEDICAID QMB ONLY