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: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 FIT SPORT LIFE BLVD STE 102
ROCKWALL TX
75032-6939
US

IV. Provider business mailing address

14287 N 87TH ST STE 220
SCOTTSDALE AZ
85260-3698
US

V. Phone/Fax

Practice location:
  • Phone: 945-262-9538
  • Fax: 945-305-4002
Mailing address:
  • Phone: 480-937-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1407100
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1407100
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: