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General NPI Number Information
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NPI Number | 1679714125
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Entity Type | Individual
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Provider Name | BOYD THEODORE CANTRELL III M.P.T.
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Gender | Male
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 502 W HIGHLAND BLVD
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City | INVERNESS
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State | FL
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Zip | 34452-4720
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Country | US
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Telephone | 352-344-6425
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Fax |
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Provider Business Mailing Address
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Address Line | 7911 SW 181ST CIR
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City | DUNNELLON
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State | FL
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Zip | 34432-2511
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Country | US
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Telephone | 352-239-6266
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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 | PT15361
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License Number State | FL
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