Provider Demographics
NPI:1104788306
Name:BOYER, BROOKS A
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:A
Last Name:BOYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 SQUARE TURN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2294
Mailing Address - Country:US
Mailing Address - Phone:531-204-0009
Mailing Address - Fax:
Practice Address - Street 1:1712 SQUARE TURN BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2294
Practice Address - Country:US
Practice Address - Phone:531-204-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-26
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1238225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant