Provider Demographics
NPI:1013032390
Name:BOYKO, LISA (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BOYKO
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 1:1280 CREEKSIDE ST
Mailing Address - Street 2:#101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1948
Mailing Address - Country:US
Mailing Address - Phone:239-624-0380
Mailing Address - Fax:239-435-0119
Practice Address - Street 1:1280 CREEKSIDE ST
Practice Address - Street 2:#101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1948
Practice Address - Country:US
Practice Address - Phone:239-624-0380
Practice Address - Fax:239-435-0119
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0P2FOtherBCBS
FLIA015ZMedicare PIN