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General NPI Number Information
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NPI Number | 1760054886
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Entity Type | Individual
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Provider Name | JESSE BOYLE DPT
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Gender | Male
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 10390 COLOMA RD STE 7
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-2152
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Country | US
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Telephone | 916-858-0950
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Fax | 916-858-0972
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Provider Business Mailing Address
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Address Line | 1675 CREEKSIDE DR STE 101
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City | FOLSOM
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State | CA
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Zip | 95630-3891
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Country | US
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Telephone | 916-858-0950
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Fax | 916-858-0972
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 300363
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License Number State | CA
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