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NPI Code Detail

MEDICARE: TIARA JEAN BOYER MATRG

MEDICARE: TIARA JEAN BOYER MATRG
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
12255A2300XAthletic Trainer0443SD

General Provider Information

NPI Number : 1548671696
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIARA JEAN BOYER MATRG
Provider Business Mailing Address
First Line : 4717 SOUTHPOINTE DR
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-6314
Country : US
Telephone Number : 605-431-7909
Fax Number :
Provider Business Practice Location Address
First Line : 1635 CAREGIVER CIR
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-8529
Country : US
Telephone Number : 605-755-4550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2014
Last Update Date : 10/19/2023

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Directions to “ TIARA JEAN BOYER MATRG” Practice Location

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