Provider Demographics
NPI:1881871416
Name:BOYD, BRYAN HEATH
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:HEATH
Last Name:BOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 GOUGHES BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-5187
Mailing Address - Country:US
Mailing Address - Phone:828-683-2416
Mailing Address - Fax:
Practice Address - Street 1:1063 GOUGHES BRANCH RD
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748-5187
Practice Address - Country:US
Practice Address - Phone:828-683-2416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3939225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant