Provider Demographics
NPI:1780284224
Name:BOSZE, DYLAN (DPT)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:
Last Name:BOSZE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W KINGSHIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5942
Mailing Address - Country:US
Mailing Address - Phone:870-239-7188
Mailing Address - Fax:870-239-7288
Practice Address - Street 1:900 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5942
Practice Address - Country:US
Practice Address - Phone:870-239-7188
Practice Address - Fax:870-239-7288
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4641208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty