Provider Demographics
NPI:1831125194
Name:BOYLE, LEIGH
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:BOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:
Other - Last Name:HAZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 DEARBORN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NH
Mailing Address - Zip Code:03811-2229
Mailing Address - Country:US
Mailing Address - Phone:603-378-0082
Mailing Address - Fax:
Practice Address - Street 1:95 PLAISTOW RD
Practice Address - Street 2:UNIT 1
Practice Address - City:PLAISTOW
Practice Address - State:NH
Practice Address - Zip Code:03865-2827
Practice Address - Country:US
Practice Address - Phone:603-378-0082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2848225100000X
MA16491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
466632OtherTUFTS HEALTH PLAN INDIV #
NH30392896Medicaid
NHUX3528OtherMEDICARE PTAN
MAY68169OtherBCBS INDIV # MASS
NH08Y004686NH02OtherANTHEM INDIV. #
NHHA RE7769Medicare ID - Type UnspecifiedMEDICARE INDIV. #