Individual
MRS. ADA RUTH BOSARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT CMDT
Contact information
Practice address
2838 ANDREW ST, PASCAGOULA, MS 39567
(228) 762-2345
(228) 762-2365
Mailing address
2838 ANDREW ST, PASCAGOULA, MS 39567
(228) 762-2345
(228) 762-2365
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0449
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124841
—
MS
05
—
09016039
—
MS
Enumeration date
12/05/2006
Last updated
07/08/2007
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