Basic Information
| Provider Information | |||||||||
| NPI: | 1083793061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOSTON | ||||||||
| FirstName: | KARI | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | P.T., D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1502 13TH AVE W | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WILLISTON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 588013825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7016514325 | ||||||||
| FaxNumber: | 8447871839 | ||||||||
| Practice Location | |||||||||
| Address1: | 512 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WILLISTON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 588015316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017740320 | ||||||||
| FaxNumber: | 7017740337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 04/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1712 | ND | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.