Provider Demographics
NPI:1083990576
Name:BOATRIGHT, DEIDRE ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:ANN
Last Name:BOATRIGHT
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 1:1 SAVANNAH SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-6755
Mailing Address - Country:US
Mailing Address - Phone:912-503-2698
Mailing Address - Fax:
Practice Address - Street 1:1 SAVANNAH SQUARE DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-6755
Practice Address - Country:US
Practice Address - Phone:912-503-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021642225100000X
2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA