Provider Demographics
NPI:1235448127
Name:BOYO, AMIRAH (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:AMIRAH
Middle Name:
Last Name:BOYO
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10455 N CENTRAL EXPY
Mailing Address - Street 2:#109-304
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2213
Mailing Address - Country:US
Mailing Address - Phone:469-222-7077
Mailing Address - Fax:
Practice Address - Street 1:10455 N CENTRAL EXPY
Practice Address - Street 2:#109-304
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2213
Practice Address - Country:US
Practice Address - Phone:469-222-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT047093225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist