Provider Demographics
NPI:1477601656
Name:BOYD, SHERRIE LEE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SHERRIE
Middle Name:LEE
Last Name:BOYD
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6322 PRISCILLA DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647
Mailing Address - Country:US
Mailing Address - Phone:714-392-6899
Mailing Address - Fax:714-901-9441
Practice Address - Street 1:18800 DELAWARE
Practice Address - Street 2:#100
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:714-392-6899
Practice Address - Fax:714-901-9441
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT13740Medicare PIN
CAWPT13740AMedicare ID - Type UnspecifiedPHYSICAL THERAPY