Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2105157 | TX |
NPI | 1003218843 |
---|---|
Provider Name | Stephen Bosworth |
First Address | Port Arthur, TX 77642-6414 |
Second Address | Port Arthur, TX 77642-6414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 24/09/2014 |