Provider Demographics
NPI:1578683371
Name:BOYD, BETH A (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:BOYD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MCKENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2610 PETERSON RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-6806
Mailing Address - Country:US
Mailing Address - Phone:419-367-3610
Mailing Address - Fax:
Practice Address - Street 1:45 AMBERWOOD PKWY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-9765
Practice Address - Country:US
Practice Address - Phone:419-496-0414
Practice Address - Fax:419-496-0415
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-7606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist