Provider Demographics
NPI:1700686268
Name:BOSTON, BRIAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:BOSTON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536B FAIRFAX DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2865
Mailing Address - Country:US
Mailing Address - Phone:703-351-7962
Mailing Address - Fax:
Practice Address - Street 1:5001 LANGSTON BLVD STE 102A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-2538
Practice Address - Country:US
Practice Address - Phone:571-970-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist