Provider Demographics
NPI:1891390175
Name:BOYER, SHELBY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:
Last Name:BOYER
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 1:861 E COOLEY ST STE B
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-5121
Mailing Address - Country:US
Mailing Address - Phone:928-537-2678
Mailing Address - Fax:866-762-2534
Practice Address - Street 1:861 E COOLEY ST STE B
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5121
Practice Address - Country:US
Practice Address - Phone:928-537-2678
Practice Address - Fax:866-762-2534
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-013891225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant