Provider Demographics
NPI:1275745291
Name:BOISVERT, MICHELLE LOUISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LOUISE
Last Name:BOISVERT
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 1:6141 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6402
Mailing Address - Country:US
Mailing Address - Phone:208-884-1322
Mailing Address - Fax:208-884-1322
Practice Address - Street 1:6141 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6402
Practice Address - Country:US
Practice Address - Phone:208-884-1322
Practice Address - Fax:208-884-1322
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist