Provider Demographics
NPI:1306809611
Name:BOYLE ASSOCIATES PHYSICAL THERAPY
Entity type:Organization
Organization Name:BOYLE ASSOCIATES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:PETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:570-455-7108
Mailing Address - Street 1:1201B N CHURCH ST
Mailing Address - Street 2:STE 307
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1453
Mailing Address - Country:US
Mailing Address - Phone:570-455-7108
Mailing Address - Fax:570-455-8835
Practice Address - Street 1:1201B N CHURCH ST
Practice Address - Street 2:SUITE 307
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-1453
Practice Address - Country:US
Practice Address - Phone:570-455-7108
Practice Address - Fax:570-455-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1908196OtherBLUE SHIELD
PA50007032OtherCAPITAL BLUE CROSS