Healthcare Provider Details

I. General information

NPI: 1942754981
Provider Name (Legal Business Name): MARIAH KAY BOYD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12072 W MCMILLAN RD
BOISE ID
83713-2462
US

IV. Provider business mailing address

12072 W MCMILLAN RD
BOISE ID
83713-2462
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-0533
  • Fax: 208-939-3341
Mailing address:
  • Phone: 208-939-0533
  • Fax: 208-939-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34500
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-7855
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: