Provider Demographics
NPI:1518937283
Name:BOST, BRYAN CHARLES (PT, DSC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:CHARLES
Last Name:BOST
Suffix:
Gender:M
Credentials:PT, DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MAXWELL CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7719
Mailing Address - Country:US
Mailing Address - Phone:904-982-4914
Mailing Address - Fax:
Practice Address - Street 1:105 MAXWELL CT
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7719
Practice Address - Country:US
Practice Address - Phone:904-982-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004786225100000X
GA4786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty