Provider Demographics
NPI:1497782015
Name:BOYDSTUN, GUY RUSSELL JR (ATC)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:RUSSELL
Last Name:BOYDSTUN
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53-549 KAMEHAMEHA HWY. #210
Mailing Address - Street 2:
Mailing Address - City:HAUULA
Mailing Address - State:HI
Mailing Address - Zip Code:96717
Mailing Address - Country:US
Mailing Address - Phone:808-293-4959
Mailing Address - Fax:
Practice Address - Street 1:55-220 KULANUI ST
Practice Address - Street 2:BYUH BOX 1968
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762-1293
Practice Address - Country:US
Practice Address - Phone:808-293-3729
Practice Address - Fax:808-293-3763
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer