Provider Demographics
NPI:1285030056
Name:BOSWELL, PATRICK (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MAXSON ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7112
Mailing Address - Country:US
Mailing Address - Phone:585-746-2187
Mailing Address - Fax:
Practice Address - Street 1:34 MAXSON ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7112
Practice Address - Country:US
Practice Address - Phone:585-746-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005452171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist