Provider Demographics
NPI:1861647554
Name:BOYER, MICHAEL JAY (MPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAY
Last Name:BOYER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 COUNTY ROAD C
Mailing Address - Street 2:
Mailing Address - City:DESHLER
Mailing Address - State:OH
Mailing Address - Zip Code:43516-9758
Mailing Address - Country:US
Mailing Address - Phone:141-990-6108
Mailing Address - Fax:419-278-0072
Practice Address - Street 1:3816 COUNTY ROAD C
Practice Address - Street 2:
Practice Address - City:DESHLER
Practice Address - State:OH
Practice Address - Zip Code:43516-9758
Practice Address - Country:US
Practice Address - Phone:141-990-6108
Practice Address - Fax:419-278-0072
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012782225100000X
NC11848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty