=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740571140
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY BETH BOYLE P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2011
-----------------------------------------------------
Last Update Date | 04/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 WOODLANDS WAY
-----------------------------------------------------
City | BREWSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02631-5259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-240-1990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 WESTWOOD DR
-----------------------------------------------------
City | ORLEANS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02653-3474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-240-0932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 11690
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------