Provider Demographics
NPI:1407952187
Name:BOYLAND, ANA MARIE (BS PT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIE
Last Name:BOYLAND
Suffix:
Gender:F
Credentials:BS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16541 LOCKRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-4139
Mailing Address - Country:US
Mailing Address - Phone:708-560-0157
Mailing Address - Fax:708-333-6560
Practice Address - Street 1:3004 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4458
Practice Address - Country:US
Practice Address - Phone:773-521-5300
Practice Address - Fax:773-721-5305
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK11736OtherIND MEDICARE PIN
IL206904Medicare ID - Type Unspecified
ILK11736OtherIND MEDICARE PIN