Healthcare Provider Details

I. General information

NPI: 1417872425
Provider Name (Legal Business Name): SUZETTE MARIE DAVID-BOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 KEILMAN ST
SAINT JOHN IN
46373-9406
US

IV. Provider business mailing address

9615 KEILMAN ST
SAINT JOHN IN
46373-9406
US

V. Phone/Fax

Practice location:
  • Phone: 219-365-0228
  • Fax: 219-365-0229
Mailing address:
  • Phone: 219-365-0228
  • Fax: 219-365-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002769A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: