Individual
MICHAEL RAYMOND BOULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
311 THELMA DR, CASPER, WY 82609-2325
(307) 234-2662
(307) 234-8810
Mailing address
PO BOX 1790, DOUGLAS, WY 82633-1790
(307) 358-9464
(307) 358-9330
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1283
WY
Other
Enumeration date
08/04/2009
Last updated
08/04/2009
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