Provider Demographics
NPI:1144561937
Name:BOYLAN, KRISTIN L (DPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:BOYLAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:L
Other - Last Name:PACZOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3700 ULMERTON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-4235
Mailing Address - Country:US
Mailing Address - Phone:727-490-8262
Mailing Address - Fax:727-324-6595
Practice Address - Street 1:3700 ULMERTON RD STE 204
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-4235
Practice Address - Country:US
Practice Address - Phone:727-490-8262
Practice Address - Fax:727-324-6595
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-019744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist