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NPI Code Detail

MEDICARE: AMY R BOYD PTA

MEDICARE:   AMY R BOYD  PTA
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
1225200000XPhysical Therapy Assistant1344AR
2225200000XPhysical Therapy Assistant554OK

General Provider Information

NPI Number : 1689945750
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY R BOYD PTA
Provider Business Mailing Address
First Line : 459977 E 1020 RD
Second Line :
City : SALLISAW
State : OK
Zip : 74955-8995
Country : US
Telephone Number : 918-776-7410
Fax Number : 918-774-9141
Provider Business Practice Location Address
First Line : 8520 S 36TH TER
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-8880
Country : US
Telephone Number : 479-410-1740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2012
Last Update Date : 01/22/2012

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