Provider Demographics
NPI:1346426509
Name:BOYLE, SIMON (MPT, HBK)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:BOYLE
Suffix:
Gender:M
Credentials:MPT, HBK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8224 WOODSVIEW CRESENT
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L2H3G1
Mailing Address - Country:CA
Mailing Address - Phone:956-537-3661
Mailing Address - Fax:
Practice Address - Street 1:8224 WOODSVIEW CRESENT
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:ONTARIO
Practice Address - Zip Code:L2H3G1
Practice Address - Country:CA
Practice Address - Phone:956-537-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist