Provider Demographics
NPI:1740363852
Name:BOSWELL, KAREN R (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4457 POPPS FERRY RD
Mailing Address - Street 2:LT 177
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-2351
Mailing Address - Country:US
Mailing Address - Phone:228-396-0805
Mailing Address - Fax:256-350-7757
Practice Address - Street 1:2120 ENTERPRISE DR
Practice Address - Street 2:SUITE A
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4039
Practice Address - Country:US
Practice Address - Phone:228-388-1002
Practice Address - Fax:228-388-1006
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MSPT1497174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist