Provider Demographics
NPI:1144354150
Name:BOYD, LEE CHRISTOPHER (PTA)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:CHRISTOPHER
Last Name:BOYD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3086
Mailing Address - Country:US
Mailing Address - Phone:229-878-6926
Mailing Address - Fax:877-803-9867
Practice Address - Street 1:297 ALSTON ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:GA
Practice Address - Zip Code:31825-1403
Practice Address - Country:US
Practice Address - Phone:229-887-0265
Practice Address - Fax:229-887-0267
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1396225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1295867752Medicare UPIN