Basic Information
| Provider Information | |||||||||
| NPI: | 1770030470 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BOYEA | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 SHAWNEE RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223122300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032564830 | ||||||||
| FaxNumber: | 7032564826 | ||||||||
| Practice Location | |||||||||
| Address1: | 5400 SHAWNEE RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223122300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032564830 | ||||||||
| FaxNumber: | 7032564826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2016 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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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 | 2305210681 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 040375 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.