Provider Demographics
NPI:1982997714
Name:BOSTON, RENEE THOMPSON (PA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:THOMPSON
Last Name:BOSTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:88 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4532
Mailing Address - Country:US
Mailing Address - Phone:931-250-5433
Mailing Address - Fax:931-250-5434
Practice Address - Street 1:57 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4836
Practice Address - Country:US
Practice Address - Phone:931-250-5433
Practice Address - Fax:931-250-5434
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT6006225100000X
TNPA3219363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist