Provider Demographics
NPI:1689973711
Name:BOSCACCY, PATRICK NATHAN (AT,C ; LAT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:NATHAN
Last Name:BOSCACCY
Suffix:
Gender:M
Credentials:AT,C ; LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W POPLAR AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0601
Mailing Address - Country:US
Mailing Address - Phone:901-730-0681
Mailing Address - Fax:901-730-0673
Practice Address - Street 1:3087 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7912
Practice Address - Country:US
Practice Address - Phone:901-730-0681
Practice Address - Fax:901-730-0673
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty