Provider Demographics
NPI:1043749336
Name:BOSWORTH, ADRIANNE MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:MARIE
Last Name:BOSWORTH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 W ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71272-0001
Mailing Address - Country:US
Mailing Address - Phone:318-257-4789
Mailing Address - Fax:318-257-2712
Practice Address - Street 1:1450 WEST ALABAMA AVENUE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71272
Practice Address - Country:US
Practice Address - Phone:318-257-4789
Practice Address - Fax:318-257-2712
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer