Individual
JERRELL S BOSTICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.S.
Contact information
Practice address
504 RAILWAY ST, DAYTONA BEACH, FL 32114-2654
(386) 679-8532
Mailing address
504 RAILWAY ST, DAYTONA BEACH, FL 32114-2654
(386) 679-8532
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
225700000X
Massage Therapist
MA79474
FL
225700000X
Massage Therapist
Primary
MT135450
TX
Other
Enumeration date
08/11/2012
Last updated
01/13/2024
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