Provider Demographics
NPI:1598730574
Name:BYERS, JUSTIN J (MS, ATC, ACI)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:J
Last Name:BYERS
Suffix:
Gender:M
Credentials:MS, ATC, ACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 85TH LN NW
Mailing Address - Street 2:UNIT #3
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-6031
Mailing Address - Country:US
Mailing Address - Phone:651-638-6234
Mailing Address - Fax:
Practice Address - Street 1:3900 BETHEL DR
Practice Address - Street 2:BETHEL UNIVERSITY
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-6902
Practice Address - Country:US
Practice Address - Phone:651-638-6234
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer