MEDICARE: DR. ROBERT EDWARD BOYLES PT

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
1	171000000X	Military Health Care Provider	1125664	TX

General Provider Information

NPI Number	:	1760472583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT EDWARD BOYLES PT

Provider Business Mailing Address
First Line	:	438 GRAHAM RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-2612
Country	:	US
Telephone Number	:	210-221-7387
Fax Number	:

Provider Business Practice Location Address
First Line	:	3851 ROGER BROOKE DR.
Second Line	:	BROOKE ARMY MEDICAL CENTER, MCHE-QD/CREDENTIALS
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-6200
Country	:	US
Telephone Number	:	210-916-1920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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