Provider Demographics
NPI:1457898314
Name:BOYD, TARA (ATC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PAP PAW PL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:AR
Mailing Address - Zip Code:72007-9020
Mailing Address - Country:US
Mailing Address - Phone:501-259-3439
Mailing Address - Fax:
Practice Address - Street 1:150 PAP PAW PL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:AR
Practice Address - Zip Code:72007-9020
Practice Address - Country:US
Practice Address - Phone:501-259-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2000030087207PS0010X, 2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program