Provider Demographics
NPI:1093750010
Name:BOARDMAN, JOYCE MOORE (PT)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:MOORE
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:ELAINE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:25117 SW PARKWAY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1605 ELM CREEK VW
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7181
Practice Address - Country:US
Practice Address - Phone:719-633-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026867225100000X
COPTL0012036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist