Provider Demographics
NPI:1265414981
Name:BOY SWANSON, NICHOLE LEI (PT, ATC)
Entity type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:LEI
Last Name:BOY SWANSON
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 WESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-4395
Mailing Address - Country:US
Mailing Address - Phone:970-476-7510
Mailing Address - Fax:
Practice Address - Street 1:1596 SUSAN A WILLIAMS WAY
Practice Address - Street 2:SUITE D
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-6172
Practice Address - Country:US
Practice Address - Phone:928-636-7950
Practice Address - Fax:928-636-7951
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6301225100000X
CO7255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ939267Medicaid
AZ939267Medicaid