Provider Demographics
NPI:1477187623
Name:BOSTON, AMANDA (PTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BOSTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 Q ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NE
Mailing Address - Zip Code:68939-1007
Mailing Address - Country:US
Mailing Address - Phone:402-984-9566
Mailing Address - Fax:
Practice Address - Street 1:1406 Q ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NE
Practice Address - Zip Code:68939-1073
Practice Address - Country:US
Practice Address - Phone:308-425-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1067225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant