MEDICARE: MS. LETTIE BOYD LMT, MMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT010857	GA

General Provider Information

NPI Number	:	1336802560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LETTIE BOYD LMT, MMP

Provider Business Mailing Address
First Line	:	576 N FORK APT 4
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3330
Country	:	US
Telephone Number	:	412-520-2276
Fax Number	:

Provider Business Practice Location Address
First Line	:	1065 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3911
Country	:	US
Telephone Number	:	404-720-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2021
Last Update Date	:	10/14/2021

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