Provider Demographics
NPI:1205886751
Name:QUEEN, BOYD ANDREW JR (PT)
Entity type:Individual
Prefix:
First Name:BOYD
Middle Name:ANDREW
Last Name:QUEEN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:120 WILLIAM PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2150
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:919-313-1276
Practice Address - Street 1:107 E MCCLANAHAN ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2919
Practice Address - Country:US
Practice Address - Phone:919-690-8588
Practice Address - Fax:919-603-0545
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078YWOtherBCBSNC INDIVIDUAL PROVIDER ID NUMBER
NC9437OtherNC PHYSICAL THERAPY LICENSE NUMBER