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NPI Code Detail

MEDICARE: MR. KENNETH EDWARD BOYD ATC, LAT

MEDICARE: MR. KENNETH EDWARD BOYD ATC, LAT
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
12255A2300XAthletic TrainerAT3000TX
22255A2300XAthletic Trainer2437NC

General Provider Information

NPI Number : 1821225350
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENNETH EDWARD BOYD ATC, LAT
Provider Business Mailing Address
First Line : PO BOX 2126
Second Line :
City : CHAPEL HILL
State : NC
Zip : 27515-2126
Country : US
Telephone Number : 919-962-0102
Fax Number :
Provider Business Practice Location Address
First Line : JAMES A TAYLOR
Second Line :
City : CHAPEL HILL
State : NC
Zip : 27599-2126
Country : US
Telephone Number : 919-962-0102
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2009
Last Update Date : 09/02/2014

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