Breanna G Boaz, PTA
Individual provider Active NPI Physical Therapy Assistant · Black Mountain, NC
NPI 1053136366 · NPPES record last updated Nov 21, 2024
Key facts
- NPI
- 1053136366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- A7984 (NC)
- Practice address
- 200 Tabernacle Rd
Black Mountain, NC 28711-7733 - Phone
- (828) 357-3611
- NPI assigned
- Nov 21, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A7984 | NC | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A7984 | NC | Yes |
Addresses
Primary practice location
200 Tabernacle Rd
Black Mountain, NC 28711-7733
Mailing address
478 N Fork Rd
Black Mountain, NC 28711-8762
Phone (828) 279-8279
Other providers in Black Mountain, NC
- Black Mountain Neuro-Medical Treatment Center
- Black Mountain Physical Therapy, LLC
- Black Mountin Nuero Medical Treatment Center
- Daniel Blake
- Jane Blount
- Jayla Bowden
- Sandra McClure Bradish
- Diana Bright
- Laurel Evans Broadhurst
- Donald Franklen Brown II
All providers in Black Mountain, NC · Physical Therapy Assistant in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.