Provider Demographics
NPI:1467953000
Name:BOYER, MONICA JEANNE (MHS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:JEANNE
Last Name:BOYER
Suffix:
Gender:F
Credentials:MHS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MAYFIELD DRIVE
Mailing Address - Street 2:PO BOX 196
Mailing Address - City:BASKERVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23917
Mailing Address - Country:US
Mailing Address - Phone:434-738-6111
Mailing Address - Fax:
Practice Address - Street 1:175 MAYFIELD DR
Practice Address - Street 2:
Practice Address - City:BOYDTON
Practice Address - State:VA
Practice Address - Zip Code:23917-2817
Practice Address - Country:US
Practice Address - Phone:434-447-7613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-42282255A2300X
390200000X
VA01260029832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program