Provider Demographics
NPI:1063230118
Name:BOYER, AUSTIN A (DPT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:A
Last Name:BOYER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-2338
Mailing Address - Country:US
Mailing Address - Phone:651-332-3768
Mailing Address - Fax:
Practice Address - Street 1:5600 NORWICH PKWY
Practice Address - Street 2:
Practice Address - City:OAK PARK HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55082-6482
Practice Address - Country:US
Practice Address - Phone:651-275-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123652251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics