Provider Demographics
NPI:1538376017
Name:BOYD, LESLIE MICHELLE (LAT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MICHELLE
Last Name:BOYD
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-6855
Mailing Address - Country:US
Mailing Address - Phone:214-228-7924
Mailing Address - Fax:
Practice Address - Street 1:1301 DOTSY AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-3576
Practice Address - Country:US
Practice Address - Phone:432-337-6655
Practice Address - Fax:432-334-5209
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22442251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports