=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356211585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGEL BOYD LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2025
-----------------------------------------------------
Last Update Date | 11/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 731 S PEAR ORCHARD RD STE 32
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-4841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-524-8444
-----------------------------------------------------
Fax | 601-524-8444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6198 HIGHWAY 483
-----------------------------------------------------
City | LENA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39094-9590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-507-0862
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 2029
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------