Boster, Stacey Marie

Boster, Stacey Marie is an individual health care provider with primary practice located at 3016 W. Main Street Suite 200, Russellville AR 72801. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Boster, Stacey Marie can be contacted via phone (479) 967-9657.

Contact Information

Primary practice address
3016 W. Main Street Suite 200 Russellville AR 72801
Phone: (479) 967-9657
Fax: (479) 967-9658
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT2554 Arkansas

Profile Details

NPI number 1053319715
LBN Legal business name Boster, Stacey Marie
Credentials MS,PT
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2005
Last updated Sep 28th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053319715 NPPES
Arkansas MEDICAID 145572721

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