Provider Demographics
NPI:1285780007
Name:BOYCE, RICHARD JACOB (MSPT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JACOB
Last Name:BOYCE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4201
Mailing Address - Country:US
Mailing Address - Phone:301-221-8863
Mailing Address - Fax:
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:1800
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-221-8863
Practice Address - Fax:301-588-1025
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC870533225100000X
MD21117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02816P02Medicare PIN
DCG02816Medicare PIN