Provider Demographics
NPI:1144646894
Name:BOYLE, CHRISTEN SHEALEEN (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:SHEALEEN
Last Name:BOYLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3424
Mailing Address - Country:US
Mailing Address - Phone:307-335-3471
Mailing Address - Fax:073-325-3883
Practice Address - Street 1:5645 US HIGHWAY 26 STE D
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:WY
Practice Address - Zip Code:82513-9607
Practice Address - Country:US
Practice Address - Phone:307-335-3471
Practice Address - Fax:307-332-5388
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0664225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant