Individual
BRYAN ALEX BOSHART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
3501 YUCCA AVE, FORT WORTH, TX 76111-4840
(832) 922-5094
Mailing address
3501 YUCCA AVE, FORT WORTH, TX 76111-4840
(832) 922-5094
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
1315715
TX
2251X0800X
Orthopedic Physical Therapist
Primary
1315715
TX
Other
Enumeration date
06/01/2019
Last updated
06/01/2019
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