Provider Demographics
NPI:1649293481
Name:BOULEY, PATRICK (PT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BOULEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 N ROSEMONT BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6114
Mailing Address - Country:US
Mailing Address - Phone:520-232-9797
Mailing Address - Fax:520-232-9799
Practice Address - Street 1:2312 N ROSEMONT BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6114
Practice Address - Country:US
Practice Address - Phone:520-232-9797
Practice Address - Fax:520-232-9799
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist