Provider Demographics
NPI:1154673507
Name:BOE, ALLISON ANNETTE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANNETTE
Last Name:BOE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 S SANTA ROSA PL APT 4
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2768
Mailing Address - Country:US
Mailing Address - Phone:605-321-6319
Mailing Address - Fax:
Practice Address - Street 1:4513 S PRINCE OF PEACE PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-5830
Practice Address - Country:US
Practice Address - Phone:605-322-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2017-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist