Provider Demographics
NPI:1104299551
Name:BOYD, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S MILITARY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 S MILITARY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4158
Practice Address - Country:US
Practice Address - Phone:985-641-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist