Individual
ALEXIS BOSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 WILSON LOOP, WARD, AR 72176
(501) 941-5630
Mailing address
4847 PARKS RD, VAN BUREN, AR 72956-8625
(501) 941-5630
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA2432
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183418721
—
AR
Enumeration date
10/13/2010
Last updated
10/13/2010
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