Provider Demographics
NPI:1346573755
Name:BOYD, AMMIE LEE (LMT)
Entity Type:Individual
Prefix:
First Name:AMMIE
Middle Name:LEE
Last Name:BOYD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AMMIE
Other - Middle Name:LEE
Other - Last Name:JENOCOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:400 EAST MAIN STREET
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4161
Mailing Address - Country:US
Mailing Address - Phone:503-681-8125
Mailing Address - Fax:503-368-1873
Practice Address - Street 1:400 EAST MAIN STREET
Practice Address - Street 2:SUITE 180
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4161
Practice Address - Country:US
Practice Address - Phone:503-681-8125
Practice Address - Fax:503-368-1873
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11492225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist