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General NPI Number Information
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NPI Number | 1932622776
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Entity Type | Individual
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Provider Name | MARY VIRGINIA BOST DPT
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Gender | Female
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 209 RIVERWIND DR STE B
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City | PEARL
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State | MS
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Zip | 39208-5653
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Country | US
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Telephone | 769-572-5747
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Fax | 601-510-9500
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Provider Business Mailing Address
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Address Line | 209 RIVERWIND DR STE B
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City | PEARL
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State | MS
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Zip | 39208-5653
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Country | US
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Telephone | 769-572-5747
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Fax | 601-510-9500
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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 | PT4509
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License Number State | MS
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