Provider Demographics
NPI:1568599181
Name:BOYLAN, TERESA
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:BOYLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6792 RED REEF ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7648
Mailing Address - Country:US
Mailing Address - Phone:561-434-3482
Mailing Address - Fax:
Practice Address - Street 1:7410 BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE A11
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6156
Practice Address - Country:US
Practice Address - Phone:561-731-0163
Practice Address - Fax:561-731-1886
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist