Provider Demographics
NPI:1083793061
Name:BOSTON, KARI ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:ELIZABETH
Last Name:BOSTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 13TH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3825
Mailing Address - Country:US
Mailing Address - Phone:701-651-4325
Mailing Address - Fax:844-787-1839
Practice Address - Street 1:512 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5316
Practice Address - Country:US
Practice Address - Phone:701-774-0320
Practice Address - Fax:701-774-0337
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist