Provider Demographics
NPI:1457659153
Name:LAVERY, KIMBERLY BYERS (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BYERS
Last Name:LAVERY
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 1:1713 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-2464
Mailing Address - Country:US
Mailing Address - Phone:817-354-7675
Mailing Address - Fax:
Practice Address - Street 1:2310 W I-20
Practice Address - Street 2:SUITE 204
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1677
Practice Address - Country:US
Practice Address - Phone:817-466-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1037018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist