Provider Demographics
NPI:1346790052
Name:BOYD, ANGELA ROSE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ROSE
Last Name:BOYD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 WINTERGLEN CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-1886
Mailing Address - Country:US
Mailing Address - Phone:740-262-4023
Mailing Address - Fax:
Practice Address - Street 1:3060 DAYTON XENIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6393
Practice Address - Country:US
Practice Address - Phone:937-427-2225
Practice Address - Fax:937-405-1078
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33.015039225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist