Individual
KEVIN EMMETT BOIVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
14950 W MOUNTAIN VIEW BLVD APT 7205, SURPRISE, AZ 85374-4722
(219) 688-4179
Mailing address
14950 W MOUNTAIN VIEW BLVD APT 7205, SURPRISE, AZ 85374-4722
(219) 688-4179
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
MA.60745513
WA
225700000X
Massage Therapist
Primary
MT-28141
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972655132
REGENCE
WA
Enumeration date
06/18/2017
Last updated
01/04/2022
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