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General NPI Number Information
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NPI Number | 1689932634
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Entity Type | Individual
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Provider Name | LISA BOYD PT
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Gender | Female
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 1911 S NATIONAL AVE STE 302
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2213
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Country | US
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Telephone | 417-881-4164
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Fax | 417-881-1727
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Provider Business Mailing Address
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Address Line | 1911 S NATIONAL AVE STE 302
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2213
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Country | US
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Telephone | 417-881-4164
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Fax | 417-881-1727
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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 | 2012012667
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License Number State | MO
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