Provider Demographics
NPI:1487859872
Name:BOOS, TRISHA ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:ANN
Last Name:BOOS
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 1:642 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:IA
Mailing Address - Zip Code:50611-0109
Mailing Address - Country:US
Mailing Address - Phone:641-775-3392
Mailing Address - Fax:
Practice Address - Street 1:102 EAST J AVE.
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-2031
Practice Address - Country:US
Practice Address - Phone:319-824-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant