Provider Demographics
NPI:1609173343
Name:BOSTIGA PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:BOSTIGA PEDIATRIC THERAPY, LLC
Other - Org Name:BOSTIGA PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:BOSTIGA
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MSPT
Authorized Official - Phone:606-262-5158
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-0244
Mailing Address - Country:US
Mailing Address - Phone:606-262-5158
Mailing Address - Fax:267-381-3678
Practice Address - Street 1:84 VERNE HORNE DR
Practice Address - Street 2:APT. 5
Practice Address - City:STAFFORDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41256-9075
Practice Address - Country:US
Practice Address - Phone:606-262-5158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency