Provider Demographics
NPI:1164696340
Name:BYERS, TAYLOR MOWAT (PT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MOWAT
Last Name:BYERS
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 1:100 E WALTON ST
Mailing Address - Street 2:STE 700
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1448
Mailing Address - Country:US
Mailing Address - Phone:312-642-3963
Mailing Address - Fax:312-642-3966
Practice Address - Street 1:1315 MACOM DR
Practice Address - Street 2:STE 105/108
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9358
Practice Address - Country:US
Practice Address - Phone:630-369-8585
Practice Address - Fax:630-369-8581
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-016335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400130751Medicare PIN
IL216859006Medicare PIN
ILR01071Medicare PIN
IL202845006Medicare PIN