Healthcare Provider Details

I. General information

NPI: 1710288667
Provider Name (Legal Business Name): CYNTHIA A. BOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MIDDLEBORO AVE
EAST TAUNTON MA
02718-1019
US

IV. Provider business mailing address

PO BOX 104
EAST TAUNTON MA
02718-0104
US

V. Phone/Fax

Practice location:
  • Phone: 508-884-8979
  • Fax:
Mailing address:
  • Phone: 508-884-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2330
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: