Basic Information
| Provider Information | |||||||||
| NPI: | 1619251048 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOE | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MS, CES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 W BELTLINE HWY | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537132318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084177305 | ||||||||
| FaxNumber: | 6084175770 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W BELTLINE HWY | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537132318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084177305 | ||||||||
| FaxNumber: | 6084175770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2011 | ||||||||
| LastUpdateDate: | 10/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Y00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Clinical Exercise Physiologist |
No ID Information.