Basic Information
| Provider Information | |||||||||
| NPI: | 1982059986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYLES | ||||||||
| FirstName: | JODY | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2949 JOHN HAWKINS PARKWAY | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053961530 | ||||||||
| FaxNumber: | 2053961535 | ||||||||
| Practice Location | |||||||||
| Address1: | 2949 JOHN HAWKINS PARKWAY | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053961530 | ||||||||
| FaxNumber: | 2053961535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2016 | ||||||||
| LastUpdateDate: | 04/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 851 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.