Provider Demographics
NPI:1558403816
Name:BOYER, LAWRENCE DEAN (PT)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DEAN
Last Name:BOYER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 BRYANT MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:VA
Mailing Address - Zip Code:22967-2160
Mailing Address - Country:US
Mailing Address - Phone:434-361-2019
Mailing Address - Fax:
Practice Address - Street 1:1635 BRYANT MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:VA
Practice Address - Zip Code:22967-2160
Practice Address - Country:US
Practice Address - Phone:434-361-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist