Provider Demographics
NPI:1467181198
Name:BOYLE, DECLAN CONNOR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DECLAN
Middle Name:CONNOR
Last Name:BOYLE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DECLAN
Other - Middle Name:
Other - Last Name:CONNOR-BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5172 CALICOWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1805
Mailing Address - Country:US
Mailing Address - Phone:206-697-4639
Mailing Address - Fax:
Practice Address - Street 1:4220 132ND ST SE STE 101
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-8999
Practice Address - Country:US
Practice Address - Phone:425-686-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist