Provider Demographics
NPI:1831714153
Name:BOYD, LESLIE (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6137 CRAWFORDSVILLE RD STE 143
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-3731
Mailing Address - Country:US
Mailing Address - Phone:317-507-8757
Mailing Address - Fax:
Practice Address - Street 1:6137 CRAWFORDSVILLE RD STE 143
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3731
Practice Address - Country:US
Practice Address - Phone:317-507-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management