MEDICARE: BRIAN C BOYD PT

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	225100000X	Physical Therapist	PT008039	GA

General Provider Information

NPI Number	:	1841297017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN C BOYD PT

Provider Business Mailing Address
First Line	:	3231 GLYNN AVE
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4851
Country	:	US
Telephone Number	:	912-265-9006
Fax Number	:	912-265-7200

Provider Business Practice Location Address
First Line	:	3231 GLYNN AVE
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4851
Country	:	US
Telephone Number	:	912-265-9006
Fax Number	:	912-265-7200

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

Provider Enumeration Date	:	07/04/2005
Last Update Date	:	07/08/2007

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