Provider Demographics
NPI:1932279486
Name:BOSS, BURTON (MT)
Entity Type:Individual
Prefix:
First Name:BURTON
Middle Name:
Last Name:BOSS
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69730 HIGHWAY 111
Mailing Address - Street 2:SUITE 113
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2869
Mailing Address - Country:US
Mailing Address - Phone:760-328-8009
Mailing Address - Fax:
Practice Address - Street 1:69730 HIGHWAY 111
Practice Address - Street 2:SUITE 113
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2869
Practice Address - Country:US
Practice Address - Phone:760-328-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist