Individual
RAVEN CELESTE BOATMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1966 F S HILL DR, GRENADA, MS 38901-5047
(662) 226-2442
Mailing address
23845 HIGHWAY 8 E, GRENADA, MS 38901-9148
(662) 614-8291
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA6380
MS
Other
Enumeration date
04/23/2021
Last updated
04/23/2021
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