Breanna G Boaz, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A7984 Issued in NC

Practice address

200 Tabernacle Rd
Black Mountain, NC 28711-7733

Phone

(828) 357-3611

NPI assigned

Nov 21, 2024

Last updated

Nov 21, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1053136366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "478 N FORK RD",
            "city": "BLACK MOUNTAIN",
            "state": "NC",
            "postal_code": "287118762",
            "telephone_number": "828-279-8279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TABERNACLE RD",
            "city": "BLACK MOUNTAIN",
            "state": "NC",
            "postal_code": "287117733",
            "telephone_number": "828-357-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOAZ",
        "first_name": "BREANNA",
        "middle_name": "G",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-21",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NC",
            "license": "A7984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Black Mountain Neuro-Medical Treatment Center
• Black Mountain Physical Therapy, LLC
• Black Mountin Nuero Medical Treatment Center (Black Mountain Center Pharmacy)
• Daniel Blake, M.D.
• Jane Blount
• Jayla Bowden, LBA
• Sandra McClure Bradish, R.PH.
• Brandee Starling PLLC
• Diana Bright, PTA
• Laurel Evans Broadhurst, M.D.

• Physical Therapy Assistant in Black Mountain, NC
• Providers in Black Mountain, NC by specialty
• Physical Therapy Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.