Individual
MRS. STACEY MARIE BOSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,PT
Contact information
Practice address
3016 W. MAIN STREET, SUITE 200, RUSSELLVILLE, AR 72801
(479) 967-9657
(479) 967-9658
Mailing address
1520 E 13TH ST, RUSSELLVILLE, AR 72802-7437
(479) 967-9657
(479) 967-9658
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2554
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145572721
—
AR
Enumeration date
07/07/2005
Last updated
09/28/2011
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