Provider Demographics
NPI:1235488321
Name:BOYLE, KIMBERLY JO (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:BOYLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-2509
Mailing Address - Country:US
Mailing Address - Phone:570-368-8389
Mailing Address - Fax:570-368-8391
Practice Address - Street 1:1009 BROAD STREET
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754
Practice Address - Country:US
Practice Address - Phone:570-368-8389
Practice Address - Fax:570-368-8391
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00008944225100000X
PAPT024403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist