MEDICARE: MISTEN J BOYSEN D.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	9065	CO
2	225100000X	Physical Therapist	5501016687	MI

General Provider Information

NPI Number	:	1134335037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTEN J BOYSEN D.P.T.

Provider Business Mailing Address
First Line	:	5782 US HIGHWAY 31 N
Second Line	:
City	:	WILLIAMSBURG
State	:	MI
Zip	:	49690-9312
Country	:	US
Telephone Number	:	720-255-6992
Fax Number	:

Provider Business Practice Location Address
First Line	:	5782 US HIGHWAY 31 N
Second Line	:
City	:	WILLIAMSBURG
State	:	MI
Zip	:	49690-9312
Country	:	US
Telephone Number	:	720-255-6992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/21/2022

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