Provider Demographics
NPI:1073633715
Name:BOYER, KATHLEEN P (RPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:BOYER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34120 SELVA RD
Mailing Address - Street 2:#288
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3774
Mailing Address - Country:US
Mailing Address - Phone:949-661-4695
Mailing Address - Fax:
Practice Address - Street 1:2031 E ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6723
Practice Address - Country:US
Practice Address - Phone:714-279-6001
Practice Address - Fax:714-279-6025
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist