Provider Demographics
NPI:1700191897
Name:BOATRIGHT, DARCY (PT)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:BOATRIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 HEATHER GLEN CT
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4246
Mailing Address - Country:US
Mailing Address - Phone:636-327-0939
Mailing Address - Fax:636-327-0939
Practice Address - Street 1:600 MEDICAL DR
Practice Address - Street 2:SUITE 109
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3426
Practice Address - Country:US
Practice Address - Phone:636-327-1170
Practice Address - Fax:636-327-1174
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005001372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist