Provider Demographics
NPI:1376829408
Name:BOYER-DERBACK, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BOYER-DERBACK
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 1:3721 CRESCENT CT W
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-3446
Mailing Address - Country:US
Mailing Address - Phone:610-820-7667
Mailing Address - Fax:
Practice Address - Street 1:3721 CRESCENT CT W
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3446
Practice Address - Country:US
Practice Address - Phone:610-820-7667
Practice Address - Fax:610-820-7671
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0217112251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics