Provider Demographics
NPI:1063795920
Name:BOYD, JESSICA C (DPT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:C
Last Name:BOYD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:C
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4 RICHMOND SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5117
Mailing Address - Country:US
Mailing Address - Phone:401-433-4172
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:16 ARNOLD STREET
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-2902
Practice Address - Country:US
Practice Address - Phone:401-765-2030
Practice Address - Fax:401-769-7472
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist