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General NPI Number Information
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NPI Number | 1730619131
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Entity Type | Individual
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Provider Name | KEVIN EMMETT BOIVIN MT
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Gender | Male
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 14950 W MOUNTAIN VIEW BLVD APT 7205
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City | SURPRISE
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State | AZ
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Zip | 85374-4722
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Country | US
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Telephone | 219-688-4179
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Fax |
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Provider Business Mailing Address
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Address Line | 14950 W MOUNTAIN VIEW BLVD APT 7205
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City | SURPRISE
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State | AZ
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Zip | 85374-4722
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Country | US
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Telephone | 219-688-4179
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA.60745513
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-28141
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License Number State | AZ
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