Healthcare Provider Details

I. General information

NPI: 1356081590
Provider Name (Legal Business Name): TIMOTHY R BOYD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 HILLANDALE DR STE 145
LITHONIA GA
30058-4860
US

IV. Provider business mailing address

PO BOX 949
ROME GA
30162-0949
US

V. Phone/Fax

Practice location:
  • Phone: 678-418-8072
  • Fax: 678-518-0137
Mailing address:
  • Phone: 678-418-8072
  • Fax: 678-518-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP030657T
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11144
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16318
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP049748T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: