Provider Demographics
NPI:1780784280
Name:BOISVERT, LOUIS OVILA (PT)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:OVILA
Last Name:BOISVERT
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 1:809 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3933
Mailing Address - Country:US
Mailing Address - Phone:607-724-3088
Mailing Address - Fax:
Practice Address - Street 1:120 PLAZA DR
Practice Address - Street 2:SUITE E
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3640
Practice Address - Country:US
Practice Address - Phone:607-797-5414
Practice Address - Fax:607-797-6537
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008038-1225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000089685OtherGHI HMO
NY4550056OtherAETNA-EPO
NY64-01196OtherUHC-PPO
NY6697063OtherGHI PPO
NY9976077625901OtherGEICO
NY02252106Medicaid
NY3962332OtherAETNA HMO
NY4550056OtherAETNA
NY10067537OtherCDPHP
NY438125OtherMVP
NYRA 7238Medicare ID - Type Unspecified