Provider Demographics
NPI:1891001582
Name:BOYDSTON, PAMELA JEAN
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEAN
Last Name:BOYDSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:HUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:465 N HOOPER ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1406
Mailing Address - Country:US
Mailing Address - Phone:989-673-3141
Mailing Address - Fax:989-672-2601
Practice Address - Street 1:465 N HOOPER ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1406
Practice Address - Country:US
Practice Address - Phone:989-673-3141
Practice Address - Fax:989-672-2601
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1711424225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant