Provider Demographics
NPI:1629078159
Name:BOYLE, BRIAN JOSEPH (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:BOYLE
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28098-0069
Mailing Address - Country:US
Mailing Address - Phone:704-241-0889
Mailing Address - Fax:704-864-2125
Practice Address - Street 1:128 SPEEDWAY DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6879
Practice Address - Country:US
Practice Address - Phone:704-768-1013
Practice Address - Fax:704-264-0711
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7559538OtherAETNA PPO
NCD3291OtherMEDCOST
NC3484600OtherAETNA HMO
NC078V2OtherBLUE CROSS BLUE SHIELD
NC7211587Medicaid
NC7211587Medicaid