Provider Demographics
NPI:1134335037
Name:BOYSEN, MISTEN J (DPT)
Entity type:Individual
Prefix:
First Name:MISTEN
Middle Name:J
Last Name:BOYSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5782 US HIGHWAY 31 N
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-9312
Mailing Address - Country:US
Mailing Address - Phone:720-255-6992
Mailing Address - Fax:
Practice Address - Street 1:5782 US HIGHWAY 31 N
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9312
Practice Address - Country:US
Practice Address - Phone:720-255-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9065225100000X
MI5501016687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty