Provider Demographics
NPI:1932212115
Name:BOYER, CRISTIN NICOLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CRISTIN
Middle Name:NICOLE
Last Name:BOYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3491 MERCHANTS BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2026
Practice Address - Country:US
Practice Address - Phone:443-625-5370
Practice Address - Fax:410-569-2689
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD89253304OtherBC MARYLAND
MD5070-0100OtherGHMSI
3507016000OtherIBC
313PS724Medicare PIN
MD5070-0100OtherGHMSI