Provider Demographics
NPI:1376053116
Name:BOYLAND, MARK ALEKSANDER (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALEKSANDER
Last Name:BOYLAND
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3920
Mailing Address - Country:US
Mailing Address - Phone:443-831-1736
Mailing Address - Fax:
Practice Address - Street 1:9475 DEERECO RD STE 102
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2124
Practice Address - Country:US
Practice Address - Phone:410-308-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist