MEDICARE: MS. DONNA KAY BOYD ATC / LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	024	AL

General Provider Information

NPI Number	:	1649238874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA KAY BOYD ATC / LAT

Provider Business Mailing Address
First Line	:	6030 WESTVALE CIR
Second Line	:
City	:	HELENA
State	:	AL
Zip	:	35080-3951
Country	:	US
Telephone Number	:	205-253-9803
Fax Number	:

Provider Business Practice Location Address
First Line	:	6030 WESTVALE CIR
Second Line	:
City	:	HELENA
State	:	AL
Zip	:	35080-3951
Country	:	US
Telephone Number	:	205-253-9803
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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