Healthcare Provider Details

I. General information

NPI: 1295443083
Provider Name (Legal Business Name): MARTIN BOYD JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 N LEX ST
PHILADELPHIA PA
19104-1353
US

IV. Provider business mailing address

882 N LEX ST
PHILADELPHIA PA
19104-1353
US

V. Phone/Fax

Practice location:
  • Phone: 267-438-1994
  • Fax:
Mailing address:
  • Phone: 267-438-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: