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1396707469

NPI Code Detail

MEDICARE: DAWN M BOSTIC PT

MEDICARE: DAWN M BOSTIC PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00005219	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	650021104	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8928454	OTHER	WA	L&I CRIME VICTIMS
3	3824BO	OTHER	WA	REGENCE BLUE SHIELD
4	8928861	OTHER	WA	L & I CRIME VICTIMS
5	8742BO	OTHER	WA	REGENCE BLUE SHIELD
6	4517914	OTHER	WA	AETNA
7	5587BO	OTHER	WA	REGENCE BLUE SHIELD
8	911745305-98208-B002	OTHER	WA	TRICARE
9	911745305-98223-A007	OTHER	WA	TRICARE
10	0145708	OTHER	WA	DEPT. OF LABOR & INDUSTRY
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396707469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN M BOSTIC PT

Provider Business Mailing Address
First Line	:	PO BOX 5127
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98206-5127
Country	:	US
Telephone Number	:	425-304-8431
Fax Number	:

Provider Business Practice Location Address
First Line	:	8923 SOPER HILL RD
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-6882
Country	:	US
Telephone Number	:	425-339-5419
Fax Number	:	425-339-4219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	06/28/2023

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Directions to “ DAWN M BOSTIC PT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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