Provider Demographics
NPI:1669191581
Name:YOUR PT AT HOME
Entity type:Organization
Organization Name:YOUR PT AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BOST
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DSC
Authorized Official - Phone:912-572-7054
Mailing Address - Street 1:60 EXCHANGE ST STE C3
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7647
Mailing Address - Country:US
Mailing Address - Phone:912-572-7054
Mailing Address - Fax:917-746-1223
Practice Address - Street 1:105 MAXWELL CT
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324
Practice Address - Country:US
Practice Address - Phone:912-572-7054
Practice Address - Fax:917-746-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty