Provider Demographics
NPI:1407273642
Name:BOYD, JEREMY T (PT, DPT, OCS, SCS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:T
Last Name:BOYD
Suffix:
Gender:M
Credentials:PT, DPT, OCS, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 VILLAGE GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1629
Mailing Address - Country:US
Mailing Address - Phone:917-885-1760
Mailing Address - Fax:856-230-7164
Practice Address - Street 1:107 ROWAN BLVD
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2203
Practice Address - Country:US
Practice Address - Phone:856-347-0333
Practice Address - Fax:856-230-7164
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01529700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist