Boris Radisic, P.T.

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

PT004064L Issued in PA

Practice address

830 W Cypress St
Kennett Square, PA 19348-2218

Phone

(610) 444-6242

Fax

(610) 444-1391

NPI assigned

Apr 13, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073737565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 MEADOWLARK RD",
            "city": "AUDUBON",
            "state": "PA",
            "postal_code": "194031913",
            "telephone_number": "610-666-7695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 W CYPRESS ST",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193482218",
            "telephone_number": "610-444-6242",
            "fax_number": "610-444-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADISIC",
        "first_name": "BORIS",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "PA",
            "license": "PT004064L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan Raymond Quinn, PH.D.
• Quraishi Medical Practices, LLC
• Uzma A Quraishi, MD
• Sydney Grace Rabold
• Jeanne Marie Radcliffe, PT
• Richard Morrie Ram, DMD
• Sergio Lino Ramirez, MD
• Christopher Robert Randall, PHARMD
• Taylor Leigh Randel, RD, LDN
• Jennifer Ann Rapposelli, PT

• General Acute Care Hospital in Kennett Square, PA
• Providers in Kennett Square, PA by specialty
• General Acute Care Hospital in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.