Provider Demographics
NPI:1023400942
Name:BOYD, JODY (AT)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PLYMOUTH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2338
Mailing Address - Country:US
Mailing Address - Phone:952-545-0663
Mailing Address - Fax:952-545-0664
Practice Address - Street 1:2000 PLYMOUTH RD STE 200
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2338
Practice Address - Country:US
Practice Address - Phone:952-545-0663
Practice Address - Fax:952-545-0664
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA743225200000X
MN10302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant