Provider Demographics
NPI:1033967609
Name:BOYD, FRED
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
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 1:7051 FAIN PARK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7806
Mailing Address - Country:US
Mailing Address - Phone:334-293-1027
Mailing Address - Fax:
Practice Address - Street 1:7051 FAIN PARK DR
Practice Address - Street 2:STE 106
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7806
Practice Address - Country:US
Practice Address - Phone:334-293-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist