Provider Demographics
NPI:1326298639
Name:BOYD, RICHARD CLARKE (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CLARKE
Last Name:BOYD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 BELLFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-4621
Mailing Address - Country:US
Mailing Address - Phone:817-423-9472
Mailing Address - Fax:
Practice Address - Street 1:4909 BELLFLOWER WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-4621
Practice Address - Country:US
Practice Address - Phone:817-423-9472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1085751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist