MEDICARE: AMY R BOYD PTA

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	225200000X	Physical Therapy Assistant	1344	AR
2	225200000X	Physical Therapy Assistant	554	OK

General Provider Information

NPI Number	:	1689945750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY R BOYD PTA

Provider Business Mailing Address
First Line	:	459977 E 1020 RD
Second Line	:
City	:	SALLISAW
State	:	OK
Zip	:	74955-8995
Country	:	US
Telephone Number	:	918-776-7410
Fax Number	:	918-774-9141

Provider Business Practice Location Address
First Line	:	8520 S 36TH TER
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8880
Country	:	US
Telephone Number	:	479-410-1740
Fax Number	:

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

Provider Enumeration Date	:	01/22/2012
Last Update Date	:	01/22/2012

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