Provider Demographics
NPI:1225522048
Name:BOYKIN, CARLY JO EGGERS (DPT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:JO EGGERS
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:JO
Other - Last Name:EGGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4640 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5542
Mailing Address - Country:US
Mailing Address - Phone:678-679-1261
Mailing Address - Fax:678-250-9010
Practice Address - Street 1:4640 MARTIN RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5542
Practice Address - Country:US
Practice Address - Phone:678-679-1261
Practice Address - Fax:678-250-9010
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist