Provider Demographics
NPI:1205538691
Name:BOYD, ALICE JANE (PTA)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:JANE
Last Name:BOYD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 W ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7411
Mailing Address - Country:US
Mailing Address - Phone:907-714-5076
Mailing Address - Fax:
Practice Address - Street 1:232 W ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7411
Practice Address - Country:US
Practice Address - Phone:907-714-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant