Provider Demographics
NPI:1811918386
Name:BOYD, BRIAN DANIEL (PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DANIEL
Last Name:BOYD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:BOBBY
Other - Middle Name:
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:133 AYSHIRE COURT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461
Mailing Address - Country:US
Mailing Address - Phone:985-641-9768
Mailing Address - Fax:
Practice Address - Street 1:1320 LAKEWOOD DR
Practice Address - Street 2:SUITE D
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3168
Practice Address - Country:US
Practice Address - Phone:985-646-2440
Practice Address - Fax:985-646-2847
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04736R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPT357Medicare ID - Type Unspecified
LA4B732Medicare ID - Type Unspecified