Provider Demographics
NPI:1538687587
Name:BOSWORTH, GARRETT DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:DAVID
Last Name:BOSWORTH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 LOUSER RD
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003
Mailing Address - Country:US
Mailing Address - Phone:717-307-0127
Mailing Address - Fax:
Practice Address - Street 1:32 NORTHEAST DR STE 203
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2758
Practice Address - Country:US
Practice Address - Phone:717-533-0215
Practice Address - Fax:717-533-0218
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19117225100000X
225500000X
PAPT029154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA390200000XMedicaid