Provider Demographics
NPI:1487958948
Name:BOSTON, RACHAEL MARIE (PTA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:MARIE
Last Name:BOSTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7819 CONSER PL
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2820
Mailing Address - Country:US
Mailing Address - Phone:913-789-9170
Mailing Address - Fax:
Practice Address - Street 1:7819 CONSER PL
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2820
Practice Address - Country:US
Practice Address - Phone:913-789-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01458225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant