Provider Demographics
NPI:1437248465
Name:BOSWELL, SAM (BA, LMP)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:BA, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 E ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9666
Mailing Address - Country:US
Mailing Address - Phone:509-499-1434
Mailing Address - Fax:
Practice Address - Street 1:1636 W 1ST AVE STE 120
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-0611
Practice Address - Country:US
Practice Address - Phone:509-499-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015972225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist