Provider Demographics
NPI:1073575031
Name:BYRD, VIRGINIA ANN (PT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANN
Last Name:BYRD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 BRUNN SCHOOL RD STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1102
Mailing Address - Country:US
Mailing Address - Phone:505-983-0670
Mailing Address - Fax:505-983-0118
Practice Address - Street 1:404 BRUNN SCHOOL RD
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1102
Practice Address - Country:US
Practice Address - Phone:505-983-0670
Practice Address - Fax:505-983-0118
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
482278ZTV8OtherMEDICARE PTAN
NM65232254Medicaid