Provider Demographics
NPI:1306032628
Name:BOYER, JODY LYNN (PTA-AS)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:LYNN
Last Name:BOYER
Suffix:
Gender:F
Credentials:PTA-AS
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Mailing Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:SUITE #111
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3931
Mailing Address - Country:US
Mailing Address - Phone:410-384-9129
Mailing Address - Fax:410-384-9725
Practice Address - Street 1:198 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4398
Practice Address - Country:US
Practice Address - Phone:301-473-9000
Practice Address - Fax:301-473-9840
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDA2930225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant