Provider Demographics
NPI:1023063047
Name:BOARDMAN, PAULA JANE (PT)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:JANE
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:PAULA
Other - Middle Name:JANE
Other - Last Name:BAFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:23550 PARK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-730-0500
Mailing Address - Fax:313-730-0606
Practice Address - Street 1:20900 WEST RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-3352
Practice Address - Country:US
Practice Address - Phone:734-671-7255
Practice Address - Fax:734-671-3701
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1581705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist