Provider Demographics
NPI:1740411263
Name:O'BOYLE, MUTYA C (PT)
Entity Type:Individual
Prefix:
First Name:MUTYA
Middle Name:C
Last Name:O'BOYLE
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 1:3831 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1859
Mailing Address - Country:US
Mailing Address - Phone:702-876-1733
Mailing Address - Fax:702-878-2018
Practice Address - Street 1:4800 E BONANZA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3470
Practice Address - Country:US
Practice Address - Phone:702-438-3188
Practice Address - Fax:702-438-4550
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPT 2345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist