Provider Demographics
NPI:1003839994
Name:BYRNE, ELIZABETH M (MPT,ATC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:M
Last Name:BYRNE
Suffix:
Gender:F
Credentials:MPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2023
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92628-2023
Mailing Address - Country:US
Mailing Address - Phone:714-556-1600
Mailing Address - Fax:714-556-3737
Practice Address - Street 1:1700 ADAMS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4865
Practice Address - Country:US
Practice Address - Phone:714-556-1600
Practice Address - Fax:714-556-3737
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 19867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT19867AMedicare PIN