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General NPI Number Information
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NPI Number | 1710334297
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Entity Type | Individual
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Provider Name | KATHLEEN BOSTIC PT,DPT,MOT,OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 222 SHOSHONE ST E
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City | TWIN FALLS
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State | ID
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Zip | 83301-6105
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Country | US
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Telephone | 775-530-5091
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Fax |
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Provider Business Mailing Address
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Address Line | 2164 NISQUALLY ST
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City | TWIN FALLS
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State | ID
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Zip | 83301-5687
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Country | US
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Telephone | 775-530-5091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5024
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1715
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4285
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13347
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License Number State | CO
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