Provider Demographics
NPI:1851760888
Name:BOSSIE, BLAIR (PT)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:BOSSIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5268 NICHOLSON LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1009
Mailing Address - Country:US
Mailing Address - Phone:301-770-5437
Mailing Address - Fax:301-668-7008
Practice Address - Street 1:5268 NICHOLSON LN
Practice Address - Street 2:SUITE A
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1009
Practice Address - Country:US
Practice Address - Phone:301-770-5437
Practice Address - Fax:301-668-7008
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist