Provider Demographics
NPI:1922195916
Name:BOYLAN, BRIDGET M (PT, LAC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:BOYLAN
Suffix:
Gender:F
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30756
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-2756
Mailing Address - Country:US
Mailing Address - Phone:206-772-5315
Mailing Address - Fax:206-774-8751
Practice Address - Street 1:517 E MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4529
Practice Address - Country:US
Practice Address - Phone:503-610-0834
Practice Address - Fax:888-746-2736
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC2691171100000X
WA5456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7095565Medicaid
WA6275BOOtherREGENCE
WA6515BOOtherREGENCE
WA5250BOOtherREGENCE
WA0124051OtherLABOR AND INDUSTRIES
WA2370BOOtherREGENCE
WA256BOOtherREGENCE
WA0152BOOtherREGENCE
WA5250BOOtherREGENCE