Provider Demographics
NPI:1568409399
Name:BOSHAE, GEORGE GILBERT (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:GILBERT
Last Name:BOSHAE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 ELK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3371
Mailing Address - Country:US
Mailing Address - Phone:402-420-2504
Mailing Address - Fax:
Practice Address - Street 1:600 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2451
Practice Address - Country:US
Practice Address - Phone:402-489-3802
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist