Healthcare Provider Details

I. General information

NPI: 1669050563
Provider Name (Legal Business Name): CATHY BOYD PHYSICAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 HARPER RD # A
BECKLEY WV
25801-3331
US

IV. Provider business mailing address

1804 HARPER RD # A
BECKLEY WV
25801-3331
US

V. Phone/Fax

Practice location:
  • Phone: 304-250-6047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER M GROSE
Title or Position: OWNER
Credential: DC
Phone: 304-250-6047