Provider Demographics
NPI:1053768606
Name:BOSWELL, ANYA EDEN (PT)
Entity type:Individual
Prefix:MS
First Name:ANYA
Middle Name:EDEN
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3087
Mailing Address - Country:US
Mailing Address - Phone:610-644-7750
Mailing Address - Fax:610-644-8290
Practice Address - Street 1:254 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3087
Practice Address - Country:US
Practice Address - Phone:610-644-7750
Practice Address - Fax:610-644-8290
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA24225161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031385290001Medicaid
PA514767YLYHMedicare PIN