Individual
MR. ERIC WAYNE BOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
475 LAKE MICHIGAN DR NW, GRAND RAPIDS, MI 49504-5600
(616) 822-9295
Mailing address
8200 GOLFSIDE DR, JENISON, MI 49428-8401
(616) 822-9295
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501012007
MI
2251X0800X
Orthopedic Physical Therapist
5501012007
MI
Other
Enumeration date
10/22/2007
Last updated
08/16/2011
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