Provider Demographics
NPI:1992900567
Name:BOSKOUTCH, CATHERIN DARLENE (LPTA 01611)
Entity type:Individual
Prefix:
First Name:CATHERIN
Middle Name:DARLENE
Last Name:BOSKOUTCH
Suffix:
Gender:F
Credentials:LPTA 01611
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8931 FOREST VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138
Mailing Address - Country:US
Mailing Address - Phone:440-293-4526
Mailing Address - Fax:
Practice Address - Street 1:8931 FOREST VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138
Practice Address - Country:US
Practice Address - Phone:440-293-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPTA 01611225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant