Provider Demographics
NPI:1649434291
Name:BOYD, CHARLES RAYMOND (LMT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RAYMOND
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 1:2207 ALVARADO LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4209
Mailing Address - Country:US
Mailing Address - Phone:941-927-5792
Mailing Address - Fax:
Practice Address - Street 1:2207 ALVARADO LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4209
Practice Address - Country:US
Practice Address - Phone:941-927-5792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA26148225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL676303100Medicaid