Provider Demographics
NPI:1821225350
Name:BOYD, KENNETH EDWARD (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EDWARD
Last Name:BOYD
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2126
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27515-2126
Mailing Address - Country:US
Mailing Address - Phone:919-962-0102
Mailing Address - Fax:
Practice Address - Street 1:JAMES A TAYLOR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-2126
Practice Address - Country:US
Practice Address - Phone:919-962-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT30002255A2300X
NC24372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer