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General NPI Number Information
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NPI Number | 1356219794
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Entity Type | Individual
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Provider Name | EBONI BOYD
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Gender | Female
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 3111 N TUSTIN ST STE 180
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City | ORANGE
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State | CA
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Zip | 92865-1752
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Country | US
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Telephone | 714-282-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 1437 HENDERSON RIDGE LN
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City | LOGANVILLE
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State | GA
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Zip | 30052-3355
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Country | US
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Telephone | 910-476-4830
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 309043
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License Number State | CA
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