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General NPI Number Information
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NPI Number | 1477439412
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Entity Type | Individual
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Provider Name | ETHAN BOYLES PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 3101 FIT SPORT LIFE BLVD STE 102
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City | ROCKWALL
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State | TX
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Zip | 75032-6939
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Country | US
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Telephone | 945-262-9538
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Fax | 945-305-4002
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Provider Business Mailing Address
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Address Line | 14287 N 87TH ST STE 220
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-3698
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Country | US
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Telephone | 480-937-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1407100
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1407100
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License Number State | TX
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