Provider Demographics
NPI:1720274087
Name:BOYACK, COREY PAUL (PTA)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:PAUL
Last Name:BOYACK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 EMERALD CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-8142
Mailing Address - Country:US
Mailing Address - Phone:801-787-9166
Mailing Address - Fax:
Practice Address - Street 1:1051 EMERALD CT
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-8142
Practice Address - Country:US
Practice Address - Phone:801-787-9166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health