Basic Information
| Provider Information | |||||||||
| NPI: | 1396993689 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYLES | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | DALE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 COUNTY ROAD 93 | ||||||||
| Address2: | |||||||||
| City: | HALEYVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355657248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054868473 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4330 HIGHWAY 78 E | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | JASPER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355018905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052952434 | ||||||||
| FaxNumber: | 2053846117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2008 | ||||||||
| LastUpdateDate: | 08/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH1573 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.