| Mrs Stacey Marie Boster, MS,PT | |
|
409 N Elmira Ave, Russellville, AR 72802-9624 | |
| (479) 967-9657 | |
| (479) 967-9658 |
| Full Name | Mrs Stacey Marie Boster |
|---|---|
| Gender | Female |
| Speciality | Physical Therapist In Private Practice |
| Experience | 24 Years |
| Location | 409 N Elmira Ave, Russellville, Arkansas |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053319715 | NPI | - | NPPES |
| 145572721 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT2554 (Arkansas) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Lane Physical Therapy Center, Inc | 1456246818 | 4 |
| Provider Name | Lane Physical Therapy Center, Inc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1104855261 PECOS PAC ID: 1456246818 Enrollment ID: O20040216001171 |
| Mailing Address | Practice Location Address |
|---|---|
| Mrs Stacey Marie Boster, MS,PT 409 N Elmira Ave, Russellville, AR 72802-9624 Ph: (479) 967-9657 | Mrs Stacey Marie Boster, MS,PT 409 N Elmira Ave, Russellville, AR 72802-9624 Ph: (479) 967-9657 |
Seth B. Coulter, P.T. Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 115 Skyline Dr, Suite A, Russellville, AR 72802 Phone: 479-967-5155 Fax: 479-967-5141 |
Ms. Brandi Nicole Koch, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1301 Russell Rd, Russellville, AR 72802 Phone: 479-967-2316 Fax: 479-967-3639 |
Jacqueline Miller, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 500 E 3rd St, Russellville, AR 72801 Phone: 479-968-1198 Fax: 479-967-1178 |
Nicholas Paul Lensing, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 301 N Sidney Ave, Russellville, AR 72801 Phone: 479-890-5494 Fax: 479-967-0069 |
Mr. Jerry Wayne Manning, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 3016 W Main St Ste 200, Russellville, AR 72801 Phone: 479-967-9657 Fax: 479-967-9658 |
Kimberly D Mcdougal, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 301 Reasoner Ln, Russellville, AR 72802 Phone: 479-970-2175 Fax: 479-964-2126 |
Allison Young, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 500 E 3rd St, Russellville, AR 72801 Phone: 479-968-1198 |