Healthcare Provider Details

I. General information

NPI: 1760054886
Provider Name (Legal Business Name): JESSE BOYLE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10390 COLOMA RD STE 7
RANCHO CORDOVA CA
95670-2152
US

IV. Provider business mailing address

1675 CREEKSIDE DR STE 101
FOLSOM CA
95630-3891
US

V. Phone/Fax

Practice location:
  • Phone: 916-858-0950
  • Fax: 916-858-0972
Mailing address:
  • Phone: 916-858-0950
  • Fax: 916-858-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: