Provider Demographics
NPI:1346505773
Name:BOYER, RACHAEL A (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:A
Last Name:BOYER
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:A
Other - Last Name:LESAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 N ANKENY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1750
Mailing Address - Country:US
Mailing Address - Phone:515-965-5311
Mailing Address - Fax:515-965-5301
Practice Address - Street 1:309 N ANKENY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1750
Practice Address - Country:US
Practice Address - Phone:515-965-5311
Practice Address - Fax:515-965-5301
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19172060Medicare PIN
IAI19172Medicare PIN