Individual
DERRICK BOYD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA, BS
Contact information
Practice address
1373 DADRIAN PROFESSIONAL PARK, GODFREY, IL 62035-1767
(706) 261-8467
Mailing address
1978 OBERLIN DR APT 1978, SAINT LOUIS, MO 63146-2868
(618) 292-7886
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
160.008973
IL
225200000X
Physical Therapy Assistant
Primary
2020030538
MO
Other
Enumeration date
08/09/2020
Last updated
11/18/2020
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