Provider Demographics
NPI:1205854130
Name:BOYLE, ROBERT B (MPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:B
Last Name:BOYLE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7225
Mailing Address - Country:US
Mailing Address - Phone:301-707-9017
Mailing Address - Fax:
Practice Address - Street 1:157 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2319
Practice Address - Country:US
Practice Address - Phone:301-722-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017410225100000X
MD19315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5012752OtherAETNA
MD687010-02OtherCAREFIRST BCBS
PAB01760688OtherHIGHMARK BLUE SHIELD
MDS8760002OtherFEDERAL BCBS
MD372318OtherMAMSI
PAB01760688OtherHIGHMARK BLUE SHIELD