Emanuel Lucian Boar, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

99094140A Issued in IN

Practice address

3630 Illinois Rd
Fort Wayne, IN 46804-2062

Phone

(260) 255-6494

Fax

(260) 399-2075

NPI assigned

Jul 8, 2019

Last updated

Aug 18, 2023By the provider in NPPES

Sex

Male

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

Enrolled in IN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Therapy and Performance LLC

  dba Atp

  • Physical Therapist
  • Fort Wayne, IN
  • NPI 1518583038
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1972165272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 ILLINOIS RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042062",
            "telephone_number": "260-255-6494",
            "fax_number": "260-399-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 ILLINOIS RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042062",
            "telephone_number": "260-255-6494",
            "fax_number": "260-399-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOAR",
        "first_name": "EMANUEL",
        "middle_name": "LUCIAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-08",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "99094140A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Crescent Blue Star Medical of Indiana, Inc
• Corey M Blum
• Michael Lloyd Blum, M.D.
• James Ervin Blume, O.D.
• Rebecca Marie Blume, PA-C
• Bonnie Boatwright, LPN
• Lisa S Bobay, PA-C
• Nicole M Bobay, MPT, WCS, CIMT, CSCS
• Jared Bobcean, MT-BC
• Eric James Bobilya, OT

• Physical Therapist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.