Provider Demographics
NPI:1497546113
Name:BOYD, REBECCA (LMT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 RIDGE RD APT 6
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-2644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:217-483-6294
Practice Address - Street 1:351 WILLIAMS LN
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-1044
Practice Address - Country:US
Practice Address - Phone:217-483-1551
Practice Address - Fax:217-483-6294
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.021773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist