Provider Demographics
NPI:1386017945
Name:BOIES, SABINA JOLANTA
Entity type:Individual
Prefix:
First Name:SABINA
Middle Name:JOLANTA
Last Name:BOIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SABINA
Other - Middle Name:JOLANTA
Other - Last Name:MONIUSZKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 814
Mailing Address - Street 2:1420 W GENEVA DR
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049
Mailing Address - Country:US
Mailing Address - Phone:847-638-0639
Mailing Address - Fax:
Practice Address - Street 1:1420 W GENEVA DR
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:UT
Practice Address - Zip Code:84049
Practice Address - Country:US
Practice Address - Phone:847-638-0639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11375A225200000X
UT8719908-2402225200000X
IL160.006231225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant