Provider Demographics
NPI:1013187467
Name:BOAS, TIMOTHY LAYNE (LMT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LAYNE
Last Name:BOAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18404 STATE ROAD 19
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-9542
Mailing Address - Country:US
Mailing Address - Phone:352-217-8550
Mailing Address - Fax:
Practice Address - Street 1:18404 STATE ROAD 19
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-9542
Practice Address - Country:US
Practice Address - Phone:352-217-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46690225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist