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NPI Code Detail

MEDICARE: MRS. KAREN D BOIDE PTA

MEDICARE: MRS. KAREN D BOIDE PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant160.004162IL

General Provider Information

NPI Number : 1548521768
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KAREN D BOIDE PTA
Provider Business Mailing Address
First Line : 1930 N CHARLES ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62221-4028
Country : US
Telephone Number : 618-277-3865
Fax Number :
Provider Business Practice Location Address
First Line : 5050 SUMMIT AVE
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62203-1026
Country : US
Telephone Number : 618-874-3597
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2012
Last Update Date : 06/05/2012

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Directions to “ MRS. KAREN D BOIDE PTA” Practice Location

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