Healthcare Provider Details

I. General information

NPI: 1144354150
Provider Name (Legal Business Name): LEE CHRISTOPHER BOYD P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 ALSTON ST
RICHLAND GA
31825-1403
US

IV. Provider business mailing address

705 PARTRIDGE DR
ALBANY GA
31707-3086
US

V. Phone/Fax

Practice location:
  • Phone: 229-887-0265
  • Fax: 229-887-0267
Mailing address:
  • Phone: 229-878-6926
  • Fax: 877-803-9867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1396
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: