Provider Demographics
NPI:1588053664
Name:BOYER, SARA ANNE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:BOYER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E. 7TH STREET, RM C200
Mailing Address - Street 2:SCHOOL OF PUBLIC HEALTH, INDIANA UNIVERSITY
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47405
Mailing Address - Country:US
Mailing Address - Phone:812-855-3114
Mailing Address - Fax:812-856-2596
Practice Address - Street 1:1025 E. 7TH STREET, RM C200
Practice Address - Street 2:SCHOOL OF PUBLIC HEALTH, INDIANA UNIVERSITY
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405
Practice Address - Country:US
Practice Address - Phone:812-855-3114
Practice Address - Fax:812-856-2596
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002176A2083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200001358OtherBOC FOR ATHLETIC TRAINING