Provider Demographics
NPI:1366039265
Name:BOYER-EARLL, ARWEN
Entity Type:Individual
Prefix:
First Name:ARWEN
Middle Name:
Last Name:BOYER-EARLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BOWLES DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-6621
Mailing Address - Country:US
Mailing Address - Phone:682-559-8767
Mailing Address - Fax:
Practice Address - Street 1:204 BOWLES DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-6621
Practice Address - Country:US
Practice Address - Phone:682-559-8767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-25
Last Update Date:2020-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT013666225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist