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NPI Code Detail

MEDICARE: SOWMYA BOYILLA PT

MEDICARE: SOWMYA BOYILLA PT
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
1225100000XPhysical Therapist2014030407MO

General Provider Information

NPI Number : 1851820427
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOWMYA BOYILLA PT
Provider Business Mailing Address
First Line : 14475 GREENCASTLE DR APT 3
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63017-8229
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 936 CHARBONIER RD
Second Line :
City : FLORISSANT
State : MO
Zip : 63031-5220
Country : US
Telephone Number : 314-831-4800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2017
Last Update Date : 06/07/2017

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Directions to “ SOWMYA BOYILLA PT” Practice Location

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