Provider Demographics
NPI:1679770358
Name:BOYD, GWENDOLYN JEAN (PT)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:JEAN
Last Name:BOYD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 N LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-6610
Mailing Address - Country:US
Mailing Address - Phone:561-207-0989
Mailing Address - Fax:561-683-2875
Practice Address - Street 1:1602 N LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-6610
Practice Address - Country:US
Practice Address - Phone:561-207-0989
Practice Address - Fax:561-683-2875
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist