Provider Demographics
NPI:1104485341
Name:BOYCE, QUINCY RAE (LMT)
Entity type:Individual
Prefix:
First Name:QUINCY
Middle Name:RAE
Last Name:BOYCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:QUINCY
Other - Middle Name:RAE
Other - Last Name:BOYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:406 SOUTH ELLA STREET
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-627-8718
Mailing Address - Fax:
Practice Address - Street 1:406 SOUTH ELLA STREET
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-627-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-3526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist