=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497546113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA BOYD LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2025
-----------------------------------------------------
Last Update Date | 05/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 351 WILLIAMS LN
-----------------------------------------------------
City | CHATHAM
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62629-1044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-483-1551
-----------------------------------------------------
Fax | 217-483-6294
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1827 RIDGE RD APT 6
-----------------------------------------------------
City | CHATHAM
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62629-2644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 217-483-6294
-----------------------------------------------------
=====================================================
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 | 227.021773
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------