Healthcare Provider Details

I. General information

NPI: 1477439412
Provider Name (Legal Business Name): ETHAN BOYLES PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR STE 350
COLORADO SPRINGS CO
80920-7582
US

IV. Provider business mailing address

8540 SCARBOROUGH DR STE 350
COLORADO SPRINGS CO
80920-7582
US

V. Phone/Fax

Practice location:
  • Phone: 719-590-7777
  • Fax: 719-590-7121
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058443T
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1407100
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: