Provider Demographics
NPI:1477581981
Name:BOYD, RYAN M (ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:BOYD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LANTHORN RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2450
Mailing Address - Country:US
Mailing Address - Phone:508-393-3524
Mailing Address - Fax:
Practice Address - Street 1:85 CONSTITUTION LN
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3694
Practice Address - Country:US
Practice Address - Phone:978-750-8188
Practice Address - Fax:978-750-8186
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17452255A2300X
MA19440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer