Healthcare Provider Details

I. General information

NPI: 1831714153
Provider Name (Legal Business Name): LESLIE BOYD CERTIFIED HAIR LOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6137 CRAWFORDSVILLE RD STE 143
INDIANAPOLIS IN
46224-3731
US

IV. Provider business mailing address

6137 CRAWFORDSVILLE RD STE 143
INDIANAPOLIS IN
46224-3731
US

V. Phone/Fax

Practice location:
  • Phone: 317-507-8757
  • Fax:
Mailing address:
  • Phone: 317-507-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: