Provider Demographics
NPI:1639420656
Name:BOLYARD, ELIZABETH PAYTON (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:PAYTON
Last Name:BOLYARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 DURALEIGH RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3534
Mailing Address - Country:US
Mailing Address - Phone:919-881-4382
Mailing Address - Fax:919-881-4320
Practice Address - Street 1:4510 DURALEIGH RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3534
Practice Address - Country:US
Practice Address - Phone:919-881-4382
Practice Address - Fax:919-881-4320
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3368225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant