Provider Demographics
NPI:1043710031
Name:BOILEAU, MARCIA (PT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:BOILEAU
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 1:26850 PROVIDENCE PKWY STE 163
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1254
Mailing Address - Country:US
Mailing Address - Phone:248-465-4190
Mailing Address - Fax:248-465-4894
Practice Address - Street 1:26850 PROVIDENCE PKWY STE 163
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1254
Practice Address - Country:US
Practice Address - Phone:248-465-4190
Practice Address - Fax:248-465-4894
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist