Provider Demographics
NPI:1336885292
Name:BOYD, BRENDON (DPT)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:
Last Name:BOYD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 STATE RD
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-8908
Mailing Address - Country:US
Mailing Address - Phone:302-540-5641
Mailing Address - Fax:
Practice Address - Street 1:11421 OLD GLENN HWY STE 101
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7783
Practice Address - Country:US
Practice Address - Phone:907-622-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030102225100000X
TN12873225100000X
AK193669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist