Provider Demographics
NPI:1659490654
Name:BOYD, JEANEA PIPPIN (PTA)
Entity Type:Individual
Prefix:PROF
First Name:JEANEA
Middle Name:PIPPIN
Last Name:BOYD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 LONG RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PINETOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27865-9654
Mailing Address - Country:US
Mailing Address - Phone:252-927-2568
Mailing Address - Fax:
Practice Address - Street 1:1375 COWELL FARM RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3495
Practice Address - Country:US
Practice Address - Phone:252-975-4395
Practice Address - Fax:252-975-4112
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3049225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant