Provider Demographics
NPI:1669623286
Name:BOYLE, NICOLE ANN (MSPT, DPT)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ANN
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MSPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1200
Mailing Address - Country:US
Mailing Address - Phone:607-687-8929
Mailing Address - Fax:607-687-8153
Practice Address - Street 1:1277 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1200
Practice Address - Country:US
Practice Address - Phone:607-687-8929
Practice Address - Fax:607-687-8153
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026202-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist