Provider Demographics
NPI:1982220315
Name:BOYER, ALEXANDER TIMOTHY (DPT)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:TIMOTHY
Last Name:BOYER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 NORTHERN MEADOWS PKWY APT 202
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-1138
Mailing Address - Country:US
Mailing Address - Phone:651-353-7547
Mailing Address - Fax:
Practice Address - Street 1:110 PARK DR
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WI
Practice Address - Zip Code:54730-8902
Practice Address - Country:US
Practice Address - Phone:715-962-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11807208100000X, 225100000X
WI15133-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation