Provider Demographics
NPI:1144214685
Name:BOYLES, PATRICK SCOTT (DPT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:SCOTT
Last Name:BOYLES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 BOARDWALK
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6332
Mailing Address - Country:US
Mailing Address - Phone:405-447-1991
Mailing Address - Fax:405-447-1198
Practice Address - Street 1:2340 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6589
Practice Address - Country:US
Practice Address - Phone:405-392-3322
Practice Address - Fax:405-392-3356
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100849060BMedicaid
OK$$$$$$$$$Medicare PIN