Provider Demographics
NPI:1891222063
Name:BOYD, STEPHANIE PAULA (PT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:PAULA
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 1:603 LITTLE LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2178
Mailing Address - Country:US
Mailing Address - Phone:925-849-6395
Mailing Address - Fax:
Practice Address - Street 1:2301 CAMINO RAMON STE 160
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2031
Practice Address - Country:US
Practice Address - Phone:925-355-1900
Practice Address - Fax:925-355-1903
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28887261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy