Provider Demographics
NPI:1811929656
Name:BOYD, RODERICK STEWART (MPT)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:STEWART
Last Name:BOYD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4633 WICHERS DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3064
Mailing Address - Country:US
Mailing Address - Phone:504-347-0733
Mailing Address - Fax:504-378-3929
Practice Address - Street 1:4633 WICHERS DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3064
Practice Address - Country:US
Practice Address - Phone:504-347-0733
Practice Address - Fax:504-378-3929
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04538R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA04538ROtherPHYSICAL THERAPY LICENSE