Provider Demographics
NPI:1053093237
Name:BOYD, CHLOE TATUM (LMT)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:TATUM
Last Name:BOYD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 LATHAM CT
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-9150
Mailing Address - Country:US
Mailing Address - Phone:191-298-0636
Mailing Address - Fax:
Practice Address - Street 1:1 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2813
Practice Address - Country:US
Practice Address - Phone:912-332-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014142225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist