Provider Demographics
NPI:1265277446
Name:BOYD, JEFFERY JAY (LMT)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:JAY
Last Name:BOYD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 S 5TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4155
Mailing Address - Country:US
Mailing Address - Phone:636-724-0123
Mailing Address - Fax:
Practice Address - Street 1:1520 S 5TH ST STE 104
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-4155
Practice Address - Country:US
Practice Address - Phone:636-724-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004022011225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist