Healthcare Provider Details

I. General information

NPI: 1902255029
Provider Name (Legal Business Name): BOST PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MAXWELL CT
RICHMOND HILL GA
31324-7719
US

IV. Provider business mailing address

105 MAXWELL CT
RICHMOND HILL GA
31324-7719
US

V. Phone/Fax

Practice location:
  • Phone: 912-756-3090
  • Fax: 912-756-3070
Mailing address:
  • Phone: 912-756-3090
  • Fax: 912-756-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7463
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number7463
License Number StateGA

VIII. Authorized Official

Name: DR. CHRISTINE BOST
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 912-756-3090