Provider Demographics
NPI:1225067622
Name:LE BOEUF, RAYMOND W JR (ATC,L)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:W
Last Name:LE BOEUF
Suffix:JR
Gender:M
Credentials:ATC,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1106
Mailing Address - Country:US
Mailing Address - Phone:508-849-3448
Mailing Address - Fax:508-849-3449
Practice Address - Street 1:50 SUNSET LN
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1106
Practice Address - Country:US
Practice Address - Phone:508-849-3448
Practice Address - Fax:508-849-3449
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer