Provider Demographics
NPI:1467814723
Name:BOYLE, LAURA ROSE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ROSE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ROSE
Other - Last Name:GAYDOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:750 E 9TH AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3395
Mailing Address - Country:US
Mailing Address - Phone:303-601-5060
Mailing Address - Fax:
Practice Address - Street 1:750 E 9TH AVE STE 209
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3395
Practice Address - Country:US
Practice Address - Phone:303-601-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10822225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist