Provider Demographics
NPI:1861630121
Name:BOYD, JOHN (LMBT 3925)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BOYD
Suffix:
Gender:M
Credentials:LMBT 3925
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMBT 3925
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-0458
Mailing Address - Country:US
Mailing Address - Phone:828-230-9218
Mailing Address - Fax:
Practice Address - Street 1:348 MERRIMON AVE
Practice Address - Street 2:STE 2
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1228
Practice Address - Country:US
Practice Address - Phone:828-230-9218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-25
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLMBT 3925225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
386601-00OtherNATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE & BODYWORK