Provider Demographics
NPI:1760765192
Name:ANTWI-BOASIAKO, RICHARD JEFFREY (DPT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JEFFREY
Last Name:ANTWI-BOASIAKO
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 1:2772 SWEETBRIAR LANE
Mailing Address - Street 2:
Mailing Address - City:BRAMPTON
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L6P1P8
Mailing Address - Country:CA
Mailing Address - Phone:905-793-6788
Mailing Address - Fax:
Practice Address - Street 1:1450 EMPIRE CENTRAL DR
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4027
Practice Address - Country:US
Practice Address - Phone:866-425-5768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1201659225100000X
NCP12927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist