Provider Demographics
NPI:1790979714
Name:BOYLE, PATRICIA JEAN (PTA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JEAN
Last Name:BOYLE
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 1:5303 HUCKLEBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1222
Mailing Address - Country:US
Mailing Address - Phone:707-293-4571
Mailing Address - Fax:
Practice Address - Street 1:5303 HUCKLEBERRY WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1222
Practice Address - Country:US
Practice Address - Phone:707-293-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5093225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant