Healthcare Provider Details

I. General information

NPI: 1518011816
Provider Name (Legal Business Name): BOAZ & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 FALLS BLVD. NORTH
WYNNE AR
72396
US

IV. Provider business mailing address

1871 FALLS BLVD. NORTH
WYNNE AR
72396
US

V. Phone/Fax

Practice location:
  • Phone: 870-208-8989
  • Fax: 870-208-8107
Mailing address:
  • Phone: 870-208-8989
  • Fax: 870-208-8107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JO LYNN LYNN BOULAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 870-208-8989