Provider Demographics
NPI:1316156888
Name:BOYDE, KATHLEEN ANN (LMT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:BOYDE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3571 BRODHEAD RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3137
Mailing Address - Country:US
Mailing Address - Phone:724-774-2630
Mailing Address - Fax:
Practice Address - Street 1:3571 BRODHEAD RD
Practice Address - Street 2:SUITE #3
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3137
Practice Address - Country:US
Practice Address - Phone:724-774-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.013749174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist