Provider Demographics
NPI:1831469196
Name:BOYER, PATRICK V
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:V
Last Name:BOYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 EAST AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4902
Mailing Address - Country:US
Mailing Address - Phone:203-939-9319
Mailing Address - Fax:
Practice Address - Street 1:83 EAST AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4902
Practice Address - Country:US
Practice Address - Phone:203-939-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTT58152225400000X
2255A2300X
CT002967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist