Provider Demographics
NPI:1902232580
Name:BOSSO, ISABEL K (DPT)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:K
Last Name:BOSSO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ISABEL
Other - Middle Name:
Other - Last Name:KAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:900 JOHNNIE DODDS BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6130
Mailing Address - Country:US
Mailing Address - Phone:843-606-1490
Mailing Address - Fax:843-606-1491
Practice Address - Street 1:900 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6130
Practice Address - Country:US
Practice Address - Phone:843-606-1490
Practice Address - Fax:843-606-1491
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8702Medicare PIN