Provider Demographics
NPI:1588062376
Name:BOYER, LORI (CMT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BOYER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5065 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1037
Mailing Address - Country:US
Mailing Address - Phone:810-732-6780
Mailing Address - Fax:810-733-7246
Practice Address - Street 1:5065 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1037
Practice Address - Country:US
Practice Address - Phone:810-732-6780
Practice Address - Fax:810-733-7246
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501006990225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist