Provider Demographics
NPI:1861849424
Name:BOST, KIMBERLY TAYLOR (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:TAYLOR
Last Name:BOST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:701 E ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5170
Mailing Address - Country:US
Mailing Address - Phone:704-289-4595
Mailing Address - Fax:704-289-5829
Practice Address - Street 1:99 E RIVER DR
Practice Address - Street 2:5TH FLOOR
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3288
Practice Address - Country:US
Practice Address - Phone:704-289-4595
Practice Address - Fax:704-289-5829
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP2582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist