Provider Demographics
NPI:1902255029
Name:BOST PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:BOST PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOST
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:912-756-3090
Mailing Address - Street 1:105 MAXWELL CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7719
Mailing Address - Country:US
Mailing Address - Phone:912-756-3090
Mailing Address - Fax:912-756-3070
Practice Address - Street 1:105 MAXWELL CT
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7719
Practice Address - Country:US
Practice Address - Phone:912-756-3090
Practice Address - Fax:912-756-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74632251P0200X
GAPT7463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty