Provider Demographics
NPI:1205809449
Name:BOYD, KIRA PORTER (MSPT)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:PORTER
Last Name:BOYD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:C
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:220 BLUEWATER CV
Mailing Address - Street 2:
Mailing Address - City:CAPE CARTERET
Mailing Address - State:NC
Mailing Address - Zip Code:28584-9401
Mailing Address - Country:US
Mailing Address - Phone:252-626-0888
Mailing Address - Fax:
Practice Address - Street 1:233 BELL FORK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6471
Practice Address - Country:US
Practice Address - Phone:252-626-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078NGOtherBCBSNC
NC7211376Medicaid
NC078NGOtherBCBSNC
NCP00472533Medicare PIN