Basic Information
| Provider Information | |||||||||
| NPI: | 1053865899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYCE | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 DERRY ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171113576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178392110 | ||||||||
| FaxNumber: | 7175651934 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 N MAIN ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744014078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186081135 | ||||||||
| FaxNumber: | 9186081142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2016 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT025327 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 5697 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1032231560001 | 05 | PA | MEDICAID |