| Doctor Name: | MR. LYLE EVERETT BOARD |
| NPI Number: | 1962440404 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ATC, CSCS |
| License Number: | J00203 |
| Business Practice Address: | 8080 Bluebonnet Blvd Baton Rouge, LA - 708107827 |
| Business Phone Number: | 2254087990 |
| Business Fax Number: | 2254087989 |
| Mailing Address: | 8080 Bluebonnet Blvd, BATON ROUGE |
| State: | LA |
| Postal Code: | 708107827 |
| Phone Number: | 2254087990 |
| Fax Number: | 2254087989 |
| NPI Enumeration Date: | 06/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225500000X |
| License Number: | J00203 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals who are trained on a specific piece of equipment or technical procedure. |