Individual
MR. BOSTON HUNTER DEVORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
109 HOMEWOOD BLVD, GLASGOW, KY 42141-3468
(270) 651-6126
Mailing address
3637 BRIDGEPORT RD, EDMONTON, KY 42129-8466
(270) 590-8801
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A04587
KY
Other
Enumeration date
07/16/2024
Last updated
07/16/2024
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