Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT012400 | GA |
NPI | 1003046608 |
---|---|
Provider Name | Dr. Scott William Boyer |
First Address | Fort Gordon, GA 30905-5741 |
Second Address | Fort Gordon, GA 30905-5741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2009 |
Last Update Date | 08/10/2019 |