Healthcare Provider Details

I. General information

NPI: 1053259754
Provider Name (Legal Business Name): ELIZABETH BOSLEY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MALICK PT, DPT

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N WASHINGTON HWY
ASHLAND VA
23005-1623
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 804-798-1112
  • Fax:
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217767
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: