Provider Demographics
NPI:1942653555
Name:BOYD, DAVID ROBERT (MS,LAT,ATC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROBERT
Last Name:BOYD
Suffix:
Gender:M
Credentials:MS,LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 S HILTON ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4327
Mailing Address - Country:US
Mailing Address - Phone:304-282-1897
Mailing Address - Fax:
Practice Address - Street 1:1725 N 5TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4010
Practice Address - Country:US
Practice Address - Phone:812-238-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002437A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer